Provider Demographics
NPI:1134286388
Name:TIMOTHY W SMITH DO INC
Entity Type:Organization
Organization Name:TIMOTHY W SMITH DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:513-742-1777
Mailing Address - Street 1:289 A NORTHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3679
Mailing Address - Country:US
Mailing Address - Phone:513-742-1777
Mailing Address - Fax:513-742-2392
Practice Address - Street 1:289 A NORTHLAND BLVD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3679
Practice Address - Country:US
Practice Address - Phone:513-742-1777
Practice Address - Fax:513-742-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDB6248OtherRAILROAD MEDICARE
OH2844953Medicaid
OHDB6248OtherRAILROAD MEDICARE