Provider Demographics
NPI:1841356375
Name:KEITH B SMITH MD INC
Entity type:Organization
Organization Name:KEITH B SMITH MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-588-6500
Mailing Address - Street 1:408 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-1773
Mailing Address - Country:US
Mailing Address - Phone:724-588-6500
Mailing Address - Fax:724-588-2554
Practice Address - Street 1:408 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1773
Practice Address - Country:US
Practice Address - Phone:724-588-6500
Practice Address - Fax:724-588-2554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0567700001Medicare NSC
B96204Medicare UPIN
E27390Medicare UPIN