Provider Demographics
NPI:1114087970
Name:JILL MARTIN SMELTZER PC
Entity Type:Organization
Organization Name:JILL MARTIN SMELTZER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:276-356-5289
Mailing Address - Street 1:PO BOX 1403
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-1403
Mailing Address - Country:US
Mailing Address - Phone:276-356-5289
Mailing Address - Fax:276-628-9892
Practice Address - Street 1:389 FALLS DR NW
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210
Practice Address - Country:US
Practice Address - Phone:276-356-5289
Practice Address - Fax:276-628-9892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09780Medicare ID - Type UnspecifiedMEDICARE GROUP