Provider Demographics
NPI:1972680627
Name:SMITH, TIMOTHY W (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CARONDELET DR STE 300
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4858
Mailing Address - Country:US
Mailing Address - Phone:816-942-4500
Mailing Address - Fax:816-941-4504
Practice Address - Street 1:1004 CARONDELET DR STE 300
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4858
Practice Address - Country:US
Practice Address - Phone:816-942-4500
Practice Address - Fax:816-941-4504
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8020207R00000X, 207RC0200X, 207RP1001X
KS04-16543207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100168550CMedicaid
KSSM516703Medicaid
MO202740700Medicaid
MO14171042OtherBCBS OF KC
MO1972680627Medicaid
KS100168550CMedicaid
MO1972680627Medicaid
MOMA1922007Medicare PIN
KS130758004Medicare PIN
MO202740700Medicaid
MOMA1922007Medicare PIN