Provider Demographics
NPI:1346533700
Name:KATHLEEN SMITH MD, LLC
Entity Type:Organization
Organization Name:KATHLEEN SMITH MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-346-5412
Mailing Address - Street 1:PO BOX 1133
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-5233
Mailing Address - Country:US
Mailing Address - Phone:317-346-5412
Mailing Address - Fax:317-736-3548
Practice Address - Street 1:3015 10TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-6603
Practice Address - Country:US
Practice Address - Phone:317-346-5412
Practice Address - Fax:317-736-3548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057282A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING36637Medicare UPIN