Provider Demographics
NPI:1801067947
Name:DR. ANDREW T. SMITH, DPM, DBA AUGUSTA FOOT AND ANKLE CENTER
Entity type:Organization
Organization Name:DR. ANDREW T. SMITH, DPM, DBA AUGUSTA FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:207-623-5100
Mailing Address - Street 1:26 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5722
Mailing Address - Country:US
Mailing Address - Phone:207-623-5100
Mailing Address - Fax:208-621-1822
Practice Address - Street 1:26 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5722
Practice Address - Country:US
Practice Address - Phone:207-623-5100
Practice Address - Fax:208-621-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD1036213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME4968610001Medicare NSC