Provider Demographics
NPI:1588705271
Name:SMITH AGENCY, INC.
Entity type:Organization
Organization Name:SMITH AGENCY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:N
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-699-1060
Mailing Address - Street 1:7169 S LIVERPOOL ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1746
Mailing Address - Country:US
Mailing Address - Phone:303-699-1060
Mailing Address - Fax:303-699-2769
Practice Address - Street 1:7169 S LIVERPOOL ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80016-1746
Practice Address - Country:US
Practice Address - Phone:303-699-1060
Practice Address - Fax:303-699-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44882261QD1600X
CO96482261QD1600X
CO06566261QD1600X
CO1531585261QD1600X
CO1540493261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09146192Medicaid
CO09146200Medicaid
CO76838374Medicaid