Provider Demographics
NPI:1770969222
Name:SMITH, GOLDIE
Entity type:Individual
Prefix:
First Name:GOLDIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF INDIAN SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45015-1250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1941 PARRISH AVE
Practice Address - Street 2:
Practice Address - City:VILLAGE OF INDIAN SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45015-1250
Practice Address - Country:US
Practice Address - Phone:513-487-9436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3140121Medicaid