Healthcare Provider Details

I. General information

NPI: 1861854721
Provider Name (Legal Business Name): TENNIE L SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 17TH ST
COLUMBUS IN
47201-5351
US

IV. Provider business mailing address

1229 HOYT AVE
INDIANAPOLIS IN
46203-1104
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-5974
  • Fax: 812-375-3203
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01085633
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60881144
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01085633A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: