Provider Demographics
NPI:1831383546
Name:MJ SMITH ENTITY LLC
Entity type:Organization
Organization Name:MJ SMITH ENTITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:985-514-1584
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:70444-0623
Mailing Address - Country:US
Mailing Address - Phone:985-514-1584
Mailing Address - Fax:866-388-7842
Practice Address - Street 1:1307 3RD ST
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:LA
Practice Address - Zip Code:70444-3319
Practice Address - Country:US
Practice Address - Phone:985-514-1584
Practice Address - Fax:866-388-7842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization