Provider Demographics
NPI:1861869760
Name:SMITH FAMILY MEDICINE
Entity type:Organization
Organization Name:SMITH FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:LEVI
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-207-1296
Mailing Address - Street 1:8128 LINCOLN AVE
Mailing Address - Street 2:APT. C
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7236
Mailing Address - Country:US
Mailing Address - Phone:606-207-1296
Mailing Address - Fax:
Practice Address - Street 1:8128 LINCOLN AVE
Practice Address - Street 2:APT. C
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7236
Practice Address - Country:US
Practice Address - Phone:606-207-1296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00507508261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care