Provider Demographics
NPI:1114065844
Name:H MATT SMITH MD PS
Entity Type:Organization
Organization Name:H MATT SMITH MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-585-5500
Mailing Address - Street 1:401 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3926
Mailing Address - Country:US
Mailing Address - Phone:509-585-5500
Mailing Address - Fax:509-585-4161
Practice Address - Street 1:401 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3926
Practice Address - Country:US
Practice Address - Phone:509-585-5500
Practice Address - Fax:509-585-4161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00358OtherDEPT OF HEALTH EIP ID
WA0801186563OtherRAILROAD MEDICARE ID
WA836293000OtherREGENCE BCBS OREGON
WA0161428OtherLABOR & INDUSTRIES ID
WA348362800OtherUS DEPT OF LABOR
WA2089786OtherFIRST HEALTH ID
WA4531768OtherAETNA PROVIDER ID
WA8937316OtherCRIME VICTIMS ID
WA1658905Medicaid
WA1266OtherGROUP HEALTH COOP ID
WA9250SMOtherREGENCE ASURIS ID
WA836293000OtherREGENCE BCBS OREGON
WAE17948Medicare UPIN