Provider Demographics
NPI:1770593907
Name:SMITH IMAGING INC
Entity type:Organization
Organization Name:SMITH IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-760-8075
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:SMITH IMAGING INC
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640
Mailing Address - Country:US
Mailing Address - Phone:573-760-8075
Mailing Address - Fax:314-821-2180
Practice Address - Street 1:1101 W LIBERTY
Practice Address - Street 2:PARKLAND HEALTH CENTER
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640
Practice Address - Country:US
Practice Address - Phone:573-760-8075
Practice Address - Fax:573-760-8358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO945K1OtherBCBS
MO8707OtherHEALTHCARE USA
MOSTL1600408OtherUHC
MO14989V14989OtherGHP
MOSTL1600408OtherUHC
=========OtherTRICARE