Healthcare Provider Details

I. General information

NPI: 1831391663
Provider Name (Legal Business Name): TERESA L. SMITH, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E BELLEFONTAINE RD
HAMILTON IN
46742-9352
US

IV. Provider business mailing address

2500 E BELLEFONTAINE RD PO BOX 70
HAMILTON IN
46742-9352
US

V. Phone/Fax

Practice location:
  • Phone: 260-488-2211
  • Fax: 260-488-3046
Mailing address:
  • Phone: 260-488-2211
  • Fax: 260-488-3046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01057213A
License Number StateIN

VIII. Authorized Official

Name: DR. TERESA LYNN SMITH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 260-488-2211