Provider Demographics
NPI:1891780581
Name:SMITH, JACK D (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:D
Last Name:SMITH
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 1:410 PELLIS RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4700
Mailing Address - Country:US
Mailing Address - Phone:724-834-4448
Mailing Address - Fax:724-834-8563
Practice Address - Street 1:410 PELLIS RD STE 2B
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4700
Practice Address - Country:US
Practice Address - Phone:724-834-4448
Practice Address - Fax:724-834-8563
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015396E207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017304600002Medicaid
PAC32436Medicare UPIN
114399Medicare PIN
PA103789OtherUPMC
PAC32436Medicare UPIN