Provider Demographics
NPI:1093153819
Name:SMITH, HEIDI J (DO)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:J
Other - Last Name:COMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 CHARLES PL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2750
Mailing Address - Country:US
Mailing Address - Phone:785-840-6634
Mailing Address - Fax:
Practice Address - Street 1:1600 CHARLES PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2750
Practice Address - Country:US
Practice Address - Phone:785-537-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2020-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-2327-20207X00000X
ORDO189582207XX0005X
NM390200000X
KS05-43138207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA-2327-20OtherNEW MEXICO LICENSE