Provider Demographics
NPI:1053505826
Name:SMARTT NEUROLOGY PC
Entity Type:Organization
Organization Name:SMARTT NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMARTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:317-872-4545
Mailing Address - Street 1:9640 N AUGUSTA DR
Mailing Address - Street 2:SUITE 412
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9600
Mailing Address - Country:US
Mailing Address - Phone:317-872-4545
Mailing Address - Fax:317-872-3959
Practice Address - Street 1:9640 N AUGUSTA DR
Practice Address - Street 2:SUITE 412
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9600
Practice Address - Country:US
Practice Address - Phone:317-872-4545
Practice Address - Fax:317-872-3959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000362840OtherANTHEM BLUE SHIELD
IN200504240AMedicaid
INI21963Medicare UPIN
IN221710AMedicare PIN