Provider Demographics
NPI:1578784450
Name:DR DIANE E SMITH & ASSOC INC
Entity Type:Organization
Organization Name:DR DIANE E SMITH & ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-475-1870
Mailing Address - Street 1:3924 CLOCK POINTE TRAIL
Mailing Address - Street 2:STE #104
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2952
Mailing Address - Country:US
Mailing Address - Phone:330-475-1870
Mailing Address - Fax:330-475-1872
Practice Address - Street 1:3924 CLOCK POINTE TRAIL
Practice Address - Street 2:STE #104
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2952
Practice Address - Country:US
Practice Address - Phone:330-475-1870
Practice Address - Fax:330-475-1872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0887401Medicaid
OH0212013Medicaid
E56088Medicare UPIN
OH0887401Medicaid