Provider Demographics
NPI:1831391663
Name:TERESA L. SMITH, MD, PC
Entity type:Organization
Organization Name:TERESA L. SMITH, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-488-2211
Mailing Address - Street 1:2500 E BELLEFONTAINE RD
Mailing Address - Street 2:PO BOX 70
Mailing Address - City:HAMILTON
Mailing Address - State:IN
Mailing Address - Zip Code:46742-9352
Mailing Address - Country:US
Mailing Address - Phone:260-488-2211
Mailing Address - Fax:260-488-3046
Practice Address - Street 1:2500 E BELLEFONTAINE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:IN
Practice Address - Zip Code:46742-9352
Practice Address - Country:US
Practice Address - Phone:260-488-2211
Practice Address - Fax:260-488-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057213A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200452930AMedicaid
IN15D1019601OtherCLIA#
IN15D1019601OtherCLIA#
INBS8342937OtherDEA #
INH89804Medicare UPIN
IN200452930AMedicaid