Provider Demographics
NPI:1851844211
Name:SM MEDICAL LLC
Entity Type:Organization
Organization Name:SM MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:937-380-2185
Mailing Address - Street 1:1008 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2253
Mailing Address - Country:US
Mailing Address - Phone:937-380-2185
Mailing Address - Fax:937-534-0166
Practice Address - Street 1:1008 SUNSET DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2253
Practice Address - Country:US
Practice Address - Phone:937-380-2185
Practice Address - Fax:937-534-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP17786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP17786OtherLICENSE