Provider Demographics
NPI:1821708728
Name:SMITH, RICHARD MICHAEL (CONTRACTOR)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:CONTRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11400 PINEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GLOUSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45732-9159
Mailing Address - Country:US
Mailing Address - Phone:740-818-9380
Mailing Address - Fax:
Practice Address - Street 1:19466 CENTER ST
Practice Address - Street 2:
Practice Address - City:TRIMBLE
Practice Address - State:OH
Practice Address - Zip Code:45782-1119
Practice Address - Country:US
Practice Address - Phone:740-818-9380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty