Provider Demographics
NPI:1902004138
Name:SMITHS MEDICAL ASD, INC.
Entity Type:Organization
Organization Name:SMITHS MEDICAL ASD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-989-9150
Mailing Address - Street 1:5700 W 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46406-2617
Mailing Address - Country:US
Mailing Address - Phone:219-989-9150
Mailing Address - Fax:219-844-9031
Practice Address - Street 1:5700 W 23RD AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46406-2617
Practice Address - Country:US
Practice Address - Phone:219-989-9150
Practice Address - Fax:219-844-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5416720001Medicare NSC