Provider Demographics
NPI:1548212137
Name:SMYTH, TIMOTHY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:SMYTH
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 1:1018 CHASE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1402
Mailing Address - Country:US
Mailing Address - Phone:423-282-3379
Mailing Address - Fax:423-430-6227
Practice Address - Street 1:1018 CHASE DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1402
Practice Address - Country:US
Practice Address - Phone:423-282-3379
Practice Address - Fax:423-430-6227
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000024297208VP0014X
TN24297207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN140212AFOtherPREFERRED CARE
TN0011599008OtherCIGNA HEALTHCARE
TN146992OtherANTHEM
TN743418OtherAETNA
TNTN0106OtherJDHC JOHNSON CITY /BRISTO
TN11870OtherCARITEN
TN050072779OtherMEDICARE RAILROAD
TN3142628OtherBLUE CROSS/BLUE SHIELD
TN3850120Medicaid
TNTN0105OtherJDHC KINGSPORT
TN050072779OtherMEDICARE RAILROAD
TN11870OtherCARITEN