Provider Demographics
NPI:1023704723
Name:SMITH, BYRD TYRONE
Entity type:Individual
Prefix:MR
First Name:BYRD
Middle Name:TYRONE
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3554 CASCADE RD
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:VA
Mailing Address - Zip Code:24069-2914
Mailing Address - Country:US
Mailing Address - Phone:143-425-0141
Mailing Address - Fax:
Practice Address - Street 1:3554 CASCADE RD
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:VA
Practice Address - Zip Code:24069-2914
Practice Address - Country:US
Practice Address - Phone:143-425-0141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
VAT60253097343900000X
VAT60258162343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)