Provider Demographics
NPI:1255771598
Name:GREG SMART FAMILY PRACTICE
Entity type:Organization
Organization Name:GREG SMART FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-864-0333
Mailing Address - Street 1:209 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-5755
Mailing Address - Country:US
Mailing Address - Phone:870-864-0333
Mailing Address - Fax:870-864-0336
Practice Address - Street 1:209 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5755
Practice Address - Country:US
Practice Address - Phone:870-864-0333
Practice Address - Fax:870-864-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-6052208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106157001Medicaid
AR106157001Medicaid
AR54918Medicare PIN