Provider Demographics
NPI:1346338951
Name:SMITH, MICHAEL CLYDE (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CLYDE
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 DILLS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-7731
Mailing Address - Country:US
Mailing Address - Phone:828-586-7000
Mailing Address - Fax:
Practice Address - Street 1:68 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2722
Practice Address - Country:US
Practice Address - Phone:828-631-1725
Practice Address - Fax:828-586-7449
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31836282N00000X
NC031836367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8000180Medicaid
NC8000315Medicaid
NC31836OtherSTATE LICENSE
NC430078149OtherHARRIS RR
NC235131EOtherSWAIN CRNA
NC260293OtherCIGNA
NC8049940OtherEDS CRNA
NC430079568OtherSWAIN RR
NC235131EOtherSWAIN CRNA