Provider Demographics
NPI:1043416076
Name:RICHARD COLVILLE SMITH, M.D., INC.
Entity Type:Organization
Organization Name:RICHARD COLVILLE SMITH, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:COLVILLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-806-9263
Mailing Address - Street 1:122 ESCONDIDO AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6055
Mailing Address - Country:US
Mailing Address - Phone:760-806-9263
Mailing Address - Fax:760-806-9264
Practice Address - Street 1:122 ESCONDIDO AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6055
Practice Address - Country:US
Practice Address - Phone:760-806-9263
Practice Address - Fax:760-806-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A827520Medicaid
CAI31174Medicare UPIN
CA00A827520Medicaid