Provider Demographics
NPI:1841418563
Name:STEPHEN A. SMITH, MD, PC
Entity Type:Organization
Organization Name:STEPHEN A. SMITH, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-545-9292
Mailing Address - Street 1:1600 N GRAND AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2700
Mailing Address - Country:US
Mailing Address - Phone:719-545-9292
Mailing Address - Fax:719-545-9191
Practice Address - Street 1:1600 N GRAND AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2700
Practice Address - Country:US
Practice Address - Phone:719-545-9292
Practice Address - Fax:719-545-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO383222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM543141OtherBCBS
CO32085346Medicaid
P00161335OtherRR MEDICARE
COA94260Medicare UPIN
COC43741Medicare PIN