Provider Demographics
NPI:1689849275
Name:SMITH PHYSICIAN ASSISTANTS, PLLC
Entity Type:Organization
Organization Name:SMITH PHYSICIAN ASSISTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPA-C
Authorized Official - Prefix:
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPA-C
Authorized Official - Phone:315-785-7009
Mailing Address - Street 1:445 FACTORY ST
Mailing Address - Street 2:PO BOX 91
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2729
Mailing Address - Country:US
Mailing Address - Phone:315-782-4207
Mailing Address - Fax:315-782-8699
Practice Address - Street 1:727 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4031
Practice Address - Country:US
Practice Address - Phone:315-785-7009
Practice Address - Fax:315-785-7566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0057341363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty