Provider Demographics
NPI:1487606729
Name:SMIDDY, JOSEPH F (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:SMIDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:COEBURN
Mailing Address - State:VA
Mailing Address - Zip Code:24230-0090
Mailing Address - Country:US
Mailing Address - Phone:276-455-5556
Mailing Address - Fax:423-247-5254
Practice Address - Street 1:208 FRONT ST W
Practice Address - Street 2:
Practice Address - City:COEBURN
Practice Address - State:VA
Practice Address - Zip Code:24230
Practice Address - Country:US
Practice Address - Phone:276-455-5556
Practice Address - Fax:276-455-5557
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101018713207RP1001X
TN33413207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05950OtherTRAILBLAZER GROUP PTAN
VA055803OtherANTHEM
TN1738991OtherUNITED HEALTHCARE
TN2005685OtherBLUE CROSS BLUE SHIELD
TN5983040OtherAETNA
VA006014267OtherVIRGINIA MEDICAID
TN3153299Medicaid
TN62134825602OtherJOHN DEERE HEALTHCARE
KY64740723OtherKENTUCKY MEDICAID
TN100023154OtherPHP TENN CARE
TN5983040OtherAETNA
TN3153299Medicare PIN
TN100023154OtherPHP TENN CARE
KY64740723OtherKENTUCKY MEDICAID
VA006014267OtherVIRGINIA MEDICAID
VAC05950OtherTRAILBLAZER GROUP PTAN
TN3287305Medicare PIN
TN3153290Medicare PIN
GA291080467Medicare PIN
TN103I112877Medicare PIN
TN103G477120Medicare PIN
VAV V3876AMedicare PIN