Provider Demographics
NPI:1497854533
Name:SMITH SURGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:SMITH SURGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-842-6183
Mailing Address - Street 1:12348 OLD TESSON RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2215
Mailing Address - Country:US
Mailing Address - Phone:314-842-6183
Mailing Address - Fax:314-842-6184
Practice Address - Street 1:12348 OLD TESSON RD
Practice Address - Street 2:SUITE 180
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2215
Practice Address - Country:US
Practice Address - Phone:314-842-6183
Practice Address - Fax:314-842-6184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty