Provider Demographics
NPI:1275732638
Name:JEFFREY SMITH MD PC
Entity Type:Organization
Organization Name:JEFFREY SMITH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS/BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-223-6613
Mailing Address - Street 1:1033 BASIN AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6649
Mailing Address - Country:US
Mailing Address - Phone:701-223-6613
Mailing Address - Fax:701-221-9114
Practice Address - Street 1:1033 BASIN AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6649
Practice Address - Country:US
Practice Address - Phone:701-223-6613
Practice Address - Fax:701-221-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15343Medicaid