Provider Demographics
NPI:1073842142
Name:SMITH, HAZEL (MOA)
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MOA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28458-0820
Mailing Address - Country:US
Mailing Address - Phone:910-282-0190
Mailing Address - Fax:
Practice Address - Street 1:704 EAST CENTER STREET
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:NC
Practice Address - Zip Code:28458-0820
Practice Address - Country:US
Practice Address - Phone:910-282-0190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1073842142Medicare NSC