Healthcare Provider Details

I. General information

NPI: 1588705271
Provider Name (Legal Business Name): SMITH AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7169 S LIVERPOOL ST
CENTENNIAL CO
80016-1746
US

IV. Provider business mailing address

7169 S LIVERPOOL ST
CENTENNIAL CO
80016-1746
US

V. Phone/Fax

Practice location:
  • Phone: 303-699-1060
  • Fax: 303-699-2769
Mailing address:
  • Phone: 303-699-1060
  • Fax: 303-699-2769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number44882
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number96482
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number06566
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number1531585
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number1540493
License Number StateCO

VIII. Authorized Official

Name: MRS. LAURA N SMITH
Title or Position: FINANCIAL MANAGER
Credential:
Phone: 303-699-1060