Provider Demographics
NPI:1992761548
Name:SMITH COUNTY FAMILY PRACTICE, PC
Entity type:Organization
Organization Name:SMITH COUNTY FAMILY PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:REGEN
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-735-3993
Mailing Address - Street 1:131 HOSPITAL DR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-4017
Mailing Address - Country:US
Mailing Address - Phone:615-735-3993
Mailing Address - Fax:615-735-3693
Practice Address - Street 1:131 HOSPITAL DR
Practice Address - Street 2:SUITE 1000
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-4017
Practice Address - Country:US
Practice Address - Phone:615-735-3993
Practice Address - Fax:615-735-3693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3720787Medicare ID - Type Unspecified