Provider Demographics
NPI:1245204791
Name:RICH, JOHN SMYTHE III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SMYTHE
Last Name:RICH
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SMYTHE
Other - Middle Name:
Other - Last Name:RICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1711 RICHLAND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2635
Mailing Address - Country:US
Mailing Address - Phone:803-799-3223
Mailing Address - Fax:803-933-9460
Practice Address - Street 1:1711 RICHLAND ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2635
Practice Address - Country:US
Practice Address - Phone:803-799-3223
Practice Address - Fax:803-933-9460
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14870207Y00000X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC148708Medicaid
SCE015230281Medicare PIN
E01523Medicare UPIN