Provider Demographics
NPI:1043684632
Name:SMITH MEDICAL CLINIC
Entity Type:Organization
Organization Name:SMITH MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-237-2672
Mailing Address - Street 1:116 BASKERVILL DR
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-6185
Mailing Address - Country:US
Mailing Address - Phone:843-237-2672
Mailing Address - Fax:843-237-0369
Practice Address - Street 1:116 BASKERVILL DR
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-6185
Practice Address - Country:US
Practice Address - Phone:843-237-2672
Practice Address - Fax:843-237-0369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD22103261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health