Provider Demographics
NPI:1346418621
Name:STANTON M. SMITH
Entity Type:Organization
Organization Name:STANTON M. SMITH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:801-261-0159
Mailing Address - Street 1:279 E 5900 S
Mailing Address - Street 2:#102
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5421
Mailing Address - Country:US
Mailing Address - Phone:801-261-0159
Mailing Address - Fax:801-261-1447
Practice Address - Street 1:279 E 5900 S
Practice Address - Street 2:#102
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5421
Practice Address - Country:US
Practice Address - Phone:801-261-0159
Practice Address - Fax:801-261-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0910680001Medicare NSC