Provider Demographics
NPI:1952555716
Name:KATHY W SMITH MD PLLC
Entity Type:Organization
Organization Name:KATHY W SMITH MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-297-7001
Mailing Address - Street 1:6837 N ORACLE RD
Mailing Address - Street 2:#14
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4222
Mailing Address - Country:US
Mailing Address - Phone:520-297-7001
Mailing Address - Fax:520-297-7002
Practice Address - Street 1:6837 N ORACLE RD
Practice Address - Street 2:#14
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4222
Practice Address - Country:US
Practice Address - Phone:520-297-7001
Practice Address - Fax:520-297-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ312692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ907983Medicaid
AZI23502Medicare UPIN
AZ907983Medicaid