Provider Demographics
NPI:1750321758
Name:SMITH, HERBERT X (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:X
Last Name:SMITH
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:PO BOX 634706
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1559 SPARTA ST
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1316
Practice Address - Country:US
Practice Address - Phone:931-815-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14991207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3880646Medicaid
TN4128712OtherBLUE CROSS
TN4120801OtherBLUE CROSS
TNP00318698OtherMEDICARE RAILROAD
TNP00294880OtherMEDICARE RAILROAD
TN4128712OtherBLUE CROSS
TNP00318698OtherMEDICARE RAILROAD
TN3880647Medicare PIN