Provider Demographics
NPI:1881643146
Name:DR SCOTT SMITH LLC
Entity Type:Organization
Organization Name:DR SCOTT SMITH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:GALEN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-378-2880
Mailing Address - Street 1:2116 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-2732
Mailing Address - Country:US
Mailing Address - Phone:724-378-2880
Mailing Address - Fax:724-378-0450
Practice Address - Street 1:2116 SHEFFIELD RD
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2732
Practice Address - Country:US
Practice Address - Phone:724-378-2880
Practice Address - Fax:724-378-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001092152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012771190004Medicaid
PA0676560001Medicare NSC
PA0012771190004Medicaid