Provider Demographics
NPI:1932654340
Name:SMART IOP LLC
Entity Type:Organization
Organization Name:SMART IOP LLC
Other - Org Name:SMART IOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WOODROW
Authorized Official - Last Name:CABANISS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-869-9721
Mailing Address - Street 1:8505 BELL CREEK RD
Mailing Address - Street 2:BUILDING 'K'
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-3829
Mailing Address - Country:US
Mailing Address - Phone:804-869-9725
Mailing Address - Fax:
Practice Address - Street 1:8505 BELL CREEK RD
Practice Address - Street 2:BUILDING 'K'
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3829
Practice Address - Country:US
Practice Address - Phone:804-869-9725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder