Provider Demographics
NPI:1184952160
Name:GREG SMITH MD LLC
Entity type:Organization
Organization Name:GREG SMITH MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-248-4789
Mailing Address - Street 1:130 HUNTER STATION WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-8930
Mailing Address - Country:US
Mailing Address - Phone:812-248-4789
Mailing Address - Fax:812-248-4773
Practice Address - Street 1:130 HUNTER STATION WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-8930
Practice Address - Country:US
Practice Address - Phone:812-248-4789
Practice Address - Fax:812-248-4773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010338212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty