Provider Demographics
NPI:1154073682
Name:SMITH, RYAN LOUIS
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LOUIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25560 RICHARDS AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-2240
Mailing Address - Country:US
Mailing Address - Phone:216-956-9351
Mailing Address - Fax:
Practice Address - Street 1:25560 RICHARDS AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-2240
Practice Address - Country:US
Practice Address - Phone:216-956-9351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide