Provider Demographics
NPI:1891822714
Name:CHERYL AUSTIN SMITH, MD, INC.
Entity Type:Organization
Organization Name:CHERYL AUSTIN SMITH, MD, INC.
Other - Org Name:CSMITHMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-276-4846
Mailing Address - Street 1:820 JORDAN ST STE 240
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4512
Mailing Address - Country:US
Mailing Address - Phone:877-276-4846
Mailing Address - Fax:318-252-0560
Practice Address - Street 1:820 JORDAN ST STE 240
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4512
Practice Address - Country:US
Practice Address - Phone:877-276-4846
Practice Address - Fax:318-252-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023233207Q00000X
2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1495671Medicaid
5E714Medicare PIN
G98345Medicare UPIN