Provider Demographics
NPI:1386717478
Name:SMITH, STEPHEN C (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:800 MERCY DR
Mailing Address - Street 2:SUITE120
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-3128
Mailing Address - Country:US
Mailing Address - Phone:712-388-2770
Mailing Address - Fax:712-388-2771
Practice Address - Street 1:800 MERCY DR
Practice Address - Street 2:SUITE120
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-3128
Practice Address - Country:US
Practice Address - Phone:712-388-2770
Practice Address - Fax:712-388-2771
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA21200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA20944OtherWELLMARK
21071OtherCOVENTRY
IA1191874Medicaid
080160487OtherRAILROAD MEDICARE
0100130OtherUNITED HEALTH CARE
IA1191874Medicaid
21071OtherCOVENTRY
0100130OtherUNITED HEALTH CARE