Provider Demographics
NPI:1902298664
Name:SUSAN C. SMART, LM, CPM
Entity Type:Organization
Organization Name:SUSAN C. SMART, LM, CPM
Other - Org Name:SMART PREGNANCY & BIRTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED MIDWIFE, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:864-909-0042
Mailing Address - Street 1:950 JOLLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHESNEE
Mailing Address - State:SC
Mailing Address - Zip Code:29323-9167
Mailing Address - Country:US
Mailing Address - Phone:864-909-0042
Mailing Address - Fax:864-285-0583
Practice Address - Street 1:850 FLOYD ROAD EXT
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1048
Practice Address - Country:US
Practice Address - Phone:864-909-0042
Practice Address - Fax:864-285-0583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLMW0006176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLM0006Medicaid