Provider Demographics
NPI:1336268937
Name:TERESA A SMITH MD PA
Entity Type:Organization
Organization Name:TERESA A SMITH MD PA
Other - Org Name:MED CENTER 1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-353-1464
Mailing Address - Street 1:1688 E ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5871
Mailing Address - Country:US
Mailing Address - Phone:252-353-1464
Mailing Address - Fax:252-353-1272
Practice Address - Street 1:1688 E ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5871
Practice Address - Country:US
Practice Address - Phone:252-353-1464
Practice Address - Fax:252-353-1272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39329261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
2156385DMedicare ID - Type Unspecified
E66877Medicare UPIN