Provider Demographics
NPI:1083916894
Name:NORMA SMITH MD PA
Entity Type:Organization
Organization Name:NORMA SMITH MD PA
Other - Org Name:EASTSIDE HEALTH & GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ZULCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-484-7100
Mailing Address - Street 1:PO BOX 11708
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1708
Mailing Address - Country:US
Mailing Address - Phone:479-484-7100
Mailing Address - Fax:479-478-7255
Practice Address - Street 1:8101 MCCLURE DR STE 101
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-6040
Practice Address - Country:US
Practice Address - Phone:479-484-7100
Practice Address - Fax:479-478-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5G371OtherAR BCBS
AR5G371OtherAR BCBS