Provider Demographics
NPI:1942307210
Name:JAMES L SMITH
Entity Type:Organization
Organization Name:JAMES L SMITH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECALIZED FOSTER PARENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-426-3055
Mailing Address - Street 1:4891 W CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-1761
Mailing Address - Country:US
Mailing Address - Phone:918-426-3055
Mailing Address - Fax:918-423-6781
Practice Address - Street 1:4891 W CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-1761
Practice Address - Country:US
Practice Address - Phone:918-426-3055
Practice Address - Fax:918-423-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK454 PBQ347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle