Provider Demographics
NPI:1710937487
Name:SMITH COUNTY FAMILY CARE, P.C.
Entity Type:Organization
Organization Name:SMITH COUNTY FAMILY CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:B
Authorized Official - Last Name:KINGSBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:615-683-3400
Mailing Address - Street 1:8 NEW MIDDLETON HWY
Mailing Address - Street 2:STE A
Mailing Address - City:GORDONSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38563-6516
Mailing Address - Country:US
Mailing Address - Phone:615-683-3400
Mailing Address - Fax:615-683-3402
Practice Address - Street 1:8 NEW MIDDLETON HWY
Practice Address - Street 2:SUITE A
Practice Address - City:GORDONSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38563-6516
Practice Address - Country:US
Practice Address - Phone:615-683-3400
Practice Address - Fax:615-683-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3726378Medicaid
TN3726378Medicaid