Provider Demographics
NPI:1770932980
Name:SMITH ORTHOPEDICS & SPORTS MEDICINE, PSC
Entity type:Organization
Organization Name:SMITH ORTHOPEDICS & SPORTS MEDICINE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-833-4922
Mailing Address - Street 1:PO BOX 990
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0990
Mailing Address - Country:US
Mailing Address - Phone:606-833-4922
Mailing Address - Fax:
Practice Address - Street 1:1000 ASHLAND DR
Practice Address - Street 2:STE. 105
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7084
Practice Address - Country:US
Practice Address - Phone:606-833-4922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty