Provider Demographics
NPI:1093725012
Name:JAMES RANDALL SMITH MD PC
Entity Type:Organization
Organization Name:JAMES RANDALL SMITH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-382-4221
Mailing Address - Street 1:PO BOX 781
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24143-0781
Mailing Address - Country:US
Mailing Address - Phone:540-382-4221
Mailing Address - Fax:540-381-1889
Practice Address - Street 1:225 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6093
Practice Address - Country:US
Practice Address - Phone:540-382-4221
Practice Address - Fax:540-381-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058436174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF01769Medicare UPIN