Provider Demographics
NPI:1144417049
Name:DAVID G. SMITHSON, MD PC
Entity Type:Organization
Organization Name:DAVID G. SMITHSON, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR INPT. REHAB UNIT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:SMITHSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-943-4554
Mailing Address - Street 1:1000 CARONDELET DR
Mailing Address - Street 2:MAIL STOP #9
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4673
Mailing Address - Country:US
Mailing Address - Phone:816-943-4554
Mailing Address - Fax:816-943-4654
Practice Address - Street 1:1010 CARONDELET DR
Practice Address - Street 2:SUITE 329
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4859
Practice Address - Country:US
Practice Address - Phone:816-943-4554
Practice Address - Fax:816-943-4654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8N64273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100120320-BMedicaid
MO16504022OtherBC/BS KANSAS CITY
MO36374011OtherBLUE CROSS BLUE SHIELD KC
KS0000556265OtherBC/BS
MO207674409Medicaid
MO208100000XOtherPROIVIDER TAXONOMIE
1417947755OtherPROVIDER NPI
MOR8N64OtherPHYSICIAN LICENSE
KS04-23432OtherPHYSICIAN LICENSE
MO250002027OtherRR: MEDICARE
MO250002027OtherRR: MEDICARE
MO207674409Medicaid