Provider Demographics
NPI:1306103247
Name:SMITH FAMILY MEDICAL HEALTHCARE PLLC
Entity type:Organization
Organization Name:SMITH FAMILY MEDICAL HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:502-296-5440
Mailing Address - Street 1:332 W BROADWAY STE 216
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2131
Mailing Address - Country:US
Mailing Address - Phone:502-963-5959
Mailing Address - Fax:844-269-9707
Practice Address - Street 1:332 W BROADWAY STE 216
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2131
Practice Address - Country:US
Practice Address - Phone:502-963-5959
Practice Address - Fax:844-269-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100203630Medicaid
KYK042571Medicare PIN