Provider Demographics
NPI:1730113721
Name:SMOKY MOUNTAIN OBSTETRICS AND GYNECOLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:SMOKY MOUNTAIN OBSTETRICS AND GYNECOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEEVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-631-1960
Mailing Address - Street 1:70 THE VILLAGE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-2742
Mailing Address - Country:US
Mailing Address - Phone:828-631-1960
Mailing Address - Fax:828-586-3489
Practice Address - Street 1:70 THE VILLAGE OVERLOOK
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2742
Practice Address - Country:US
Practice Address - Phone:828-631-1960
Practice Address - Fax:828-586-3489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017PHOtherBLUE CROSS
NC5903154Medicaid
NC5903154Medicaid