Provider Demographics
NPI:1245261817
Name:SMITH INTERNAL MEDICINE GROUP LTD
Entity type:Organization
Organization Name:SMITH INTERNAL MEDICINE GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-521-2002
Mailing Address - Street 1:100 HIGHLAND AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2740
Mailing Address - Country:US
Mailing Address - Phone:401-521-2002
Mailing Address - Fax:401-521-0906
Practice Address - Street 1:100 HIGHLAND AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2740
Practice Address - Country:US
Practice Address - Phone:401-521-2002
Practice Address - Fax:401-521-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9004024Medicaid