Provider Demographics
NPI:1295015923
Name:RITCH-SMITH, BENJAMIN (CC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:RITCH-SMITH
Suffix:
Gender:M
Credentials:CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 BUSINESS BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7701
Mailing Address - Country:US
Mailing Address - Phone:907-694-6002
Mailing Address - Fax:907-694-6015
Practice Address - Street 1:11901 BUSINESS BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7701
Practice Address - Country:US
Practice Address - Phone:907-694-6002
Practice Address - Fax:907-694-6015
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC1621Medicaid
AKCMG621Medicaid