Provider Demographics
NPI:1851494330
Name:SMYTHE RICH MD PA
Entity type:Organization
Organization Name:SMYTHE RICH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SMYTHE
Authorized Official - Last Name:RICH
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:803-799-3223
Mailing Address - Street 1:1711 RICHLAND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2635
Mailing Address - Country:US
Mailing Address - Phone:803-799-3223
Mailing Address - Fax:803-933-9460
Practice Address - Street 1:1711 RICHLAND ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2635
Practice Address - Country:US
Practice Address - Phone:803-799-3223
Practice Address - Fax:803-933-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14870174400000X
SC0527178207Y00000X
SCSI CODE 78011207Y00000X
SC148708207Y00000X
2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC148708Medicaid
SCE015230281Medicare PIN
SC148708Medicaid