Provider Demographics
NPI:1427240845
Name:SMITH CHURCH OBSTETRICS & GYNECOLOGY, PC
Entity type:Organization
Organization Name:SMITH CHURCH OBSTETRICS & GYNECOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MINIELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-535-4343
Mailing Address - Street 1:63 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4940
Mailing Address - Country:US
Mailing Address - Phone:252-535-4343
Mailing Address - Fax:252-308-0977
Practice Address - Street 1:63 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4940
Practice Address - Country:US
Practice Address - Phone:252-535-4343
Practice Address - Fax:252-308-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty