Provider Demographics
NPI:1649545286
Name:SMITHOTICS LLC
Entity type:Organization
Organization Name:SMITHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ORTHOTIST PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:224-653-8411
Mailing Address - Street 1:75 MARKET ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5093
Mailing Address - Country:US
Mailing Address - Phone:224-653-8411
Mailing Address - Fax:
Practice Address - Street 1:75 MARKET ST
Practice Address - Street 2:STE 4
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5093
Practice Address - Country:US
Practice Address - Phone:224-653-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL248000569335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6708050001Medicare NSC