Provider Demographics
NPI:1366445108
Name:SMITH, BENJAMIN S (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 OLD HWY 60
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-2575
Mailing Address - Country:US
Mailing Address - Phone:270-580-2250
Mailing Address - Fax:270-580-2273
Practice Address - Street 1:107 OLD HWY 60
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-2575
Practice Address - Country:US
Practice Address - Phone:270-580-2250
Practice Address - Fax:270-580-2273
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38740207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64072887Medicaid
KYI02119Medicare UPIN
KY049202Medicare PIN