Provider Demographics
NPI:1184145815
Name:SMOKETOWN FAMILY WELLNESS CENTER CORP
Entity type:Organization
Organization Name:SMOKETOWN FAMILY WELLNESS CENTER CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:STITES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-242-7458
Mailing Address - Street 1:760 S HANCOCK ST APT B100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2449
Mailing Address - Country:US
Mailing Address - Phone:502-242-7458
Mailing Address - Fax:502-219-3673
Practice Address - Street 1:760 S HANCOCK ST APT B100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2449
Practice Address - Country:US
Practice Address - Phone:502-242-7458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty