Provider Demographics
NPI:1013947019
Name:TERRY C. SMITH, M.D., PA
Entity type:Organization
Organization Name:TERRY C. SMITH, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-388-1823
Mailing Address - Street 1:180 DEBUYS RD # B
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4402
Mailing Address - Country:US
Mailing Address - Phone:228-388-1823
Mailing Address - Fax:228-388-1825
Practice Address - Street 1:180 DEBUYS RD # B
Practice Address - Street 2:SUITE 102
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4402
Practice Address - Country:US
Practice Address - Phone:228-388-1823
Practice Address - Fax:228-388-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15469174400000X
MSPENDING332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118612Medicaid
MS00118612Medicaid