Provider Demographics
NPI:1467463950
Name:SMITH, STEPHEN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
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:PO BOX 2630
Mailing Address - Street 2:CENTRAL WV MEDCORP INC
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-2630
Mailing Address - Country:US
Mailing Address - Phone:304-637-3799
Mailing Address - Fax:304-637-3369
Practice Address - Street 1:11 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2231
Practice Address - Country:US
Practice Address - Phone:304-472-1600
Practice Address - Fax:304-472-6055
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11623207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0083382000Medicaid
WVWV11623BOtherHEALTH PLAN
WV11623OtherMEDICAL LICENSE NUMBER
WV000159893OtherINDIVIDUAL BCBS NUMBER
WV0083382000Medicaid
WV000159893OtherINDIVIDUAL BCBS NUMBER
WV0479543Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NBR
WV0479544Medicare PIN