Provider Demographics
NPI:1356525976
Name:WILLIAM HARRISON SMITH
Entity type:Organization
Organization Name:WILLIAM HARRISON SMITH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:590-786-2888
Mailing Address - Street 1:PO BOX 1658
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-0834
Mailing Address - Country:US
Mailing Address - Phone:509-786-2888
Mailing Address - Fax:509-786-2888
Practice Address - Street 1:1215 QUARTERHORSE TRL
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-2500
Practice Address - Country:US
Practice Address - Phone:509-786-2888
Practice Address - Fax:509-786-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA43050OtherSTATE LABOR AND INDUSTRY
WA9609371Medicaid
WAG000196400Medicare PIN