Provider Demographics
NPI:1144414251
Name:DR G SCOTT SMITH PC
Entity Type:Organization
Organization Name:DR G SCOTT SMITH PC
Other - Org Name:SILVER CARDIAC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING/CREDENTIALLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SCARSELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-534-1919
Mailing Address - Street 1:1290 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7229
Mailing Address - Country:US
Mailing Address - Phone:505-388-3200
Mailing Address - Fax:505-388-8016
Practice Address - Street 1:1290 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7229
Practice Address - Country:US
Practice Address - Phone:505-388-3200
Practice Address - Fax:505-388-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2006-0060207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36904261Medicaid