Provider Demographics
NPI:1922092592
Name:CC SMITH MD INC
Entity Type:Organization
Organization Name:CC SMITH MD INC
Other - Org Name:CLAUDET SMITH MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDET
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-621-5780
Mailing Address - Street 1:1200 PROSPECT ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870
Mailing Address - Country:US
Mailing Address - Phone:419-621-5780
Mailing Address - Fax:419-621-5791
Practice Address - Street 1:1200 PROSPECT ST
Practice Address - Street 2:STE 200
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870
Practice Address - Country:US
Practice Address - Phone:419-621-5780
Practice Address - Fax:419-621-5791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000322103OtherANTHEM BCBS
OH2817643Medicaid
7679166OtherAETNA
5380OtherPARAMOUNT
DB4873OtherRAILROAD MEDICARE
CC9341921Medicare ID - Type Unspecified