Provider Demographics
NPI:1720151483
Name:ROBERT L SMOAK
Entity Type:Organization
Organization Name:ROBERT L SMOAK
Other - Org Name:ROBERT L SMOAK MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMOAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-534-4254
Mailing Address - Street 1:PO BOX 2609
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-2609
Mailing Address - Country:US
Mailing Address - Phone:803-534-4254
Mailing Address - Fax:803-531-8810
Practice Address - Street 1:1739 VILLAGE PARK DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2475
Practice Address - Country:US
Practice Address - Phone:803-534-4254
Practice Address - Fax:803-531-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC138Medicaid
SC428966Medicare ID - Type UnspecifiedMEDICARE RURAL HEALTH ID