Provider Demographics
NPI:1497014161
Name:J S MICHAEL SMITH MD PA
Entity Type:Organization
Organization Name:J S MICHAEL SMITH MD PA
Other - Org Name:JOHN STEWART MICHAEL SMITH MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN STEWART
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-675-4546
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-0010
Mailing Address - Country:US
Mailing Address - Phone:850-675-4546
Mailing Address - Fax:850-675-4548
Practice Address - Street 1:14088 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565-1036
Practice Address - Country:US
Practice Address - Phone:850-675-4546
Practice Address - Fax:850-675-4548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
751241OtherCOVENTRY
2553182OtherUNITED HEALTHCARE
592200521OtherCHAMPVA
W560OtherWELLCARE
59180291OtherBLUE CROSS AND BLUE SHIELD OF ALABAMA
7839652OtherAETNA
P00368813OtherRAILROAD MEDICARE
FL272533900Medicaid
592200521OtherTRICARE
592200521OtherHUMANA
AL009996365OtherALACAID
01512OtherBLUE CROSS AND BLUE SHIELD OF FLORIDA
2357174OtherCIGNA
592200521OtherCHAMPVA
FL272533900Medicaid