Provider Demographics
NPI:1720173511
Name:DANIEL L. SMITH, D.O., INC.
Entity type:Organization
Organization Name:DANIEL L. SMITH, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OSTEOPATHIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-397-3647
Mailing Address - Street 1:11 WOODLAKE TRL
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-8113
Mailing Address - Country:US
Mailing Address - Phone:740-397-3647
Mailing Address - Fax:740-397-0908
Practice Address - Street 1:11 WOODLAKE TRL
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-8113
Practice Address - Country:US
Practice Address - Phone:740-397-3647
Practice Address - Fax:740-397-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE00627Medicare UPIN
OHDA9176061Medicare ID - Type Unspecified