MEDICARE: SMYTHE RICH MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	14870	SC
2	207Y00000X	Otolaryngology Physician	0527178	SC
3	207Y00000X	Otolaryngology Physician	SI CODE 78011	SC
4	207Y00000X	Otolaryngology Physician	148708	SC
5	2086S0122X	Plastic and Reconstructive Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851494330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMYTHE RICH MD PA

Provider Business Mailing Address
First Line	:	1711 RICHLAND ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2635
Country	:	US
Telephone Number	:	803-799-3223
Fax Number	:	803-933-9460

Provider Business Practice Location Address
First Line	:	1711 RICHLAND ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2635
Country	:	US
Telephone Number	:	803-799-3223
Fax Number	:	803-933-9460

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. JOHN SMYTHE RICH III
Credential	:	M.D.
Telephone Number	:	803-799-3223

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	09/01/2021

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Directions to “SMYTHE RICH MD PA ” Practice Location

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