Provider Demographics
NPI:1811034895
Name:J. MICHAEL SMITH MEDICAL CONSULTING INC
Entity Type:Organization
Organization Name:J. MICHAEL SMITH MEDICAL CONSULTING INC
Other - Org Name:JAMES M. SMITH, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-281-5600
Mailing Address - Street 1:532 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-5033
Mailing Address - Country:US
Mailing Address - Phone:318-281-5600
Mailing Address - Fax:318-283-2247
Practice Address - Street 1:532 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-5033
Practice Address - Country:US
Practice Address - Phone:318-281-5600
Practice Address - Fax:318-283-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1335789Medicaid
LAB65936Medicare UPIN
LA1335789Medicaid