Healthcare Provider Details

I. General information

NPI: 1639102510
Provider Name (Legal Business Name): THOMAS W. SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E. 23RD
HUTCHINSON KS
67502
US

IV. Provider business mailing address

1712 E. 23RD.
HUTCHINSON KS
67502
US

V. Phone/Fax

Practice location:
  • Phone: 620-665-2394
  • Fax: 620-662-0538
Mailing address:
  • Phone: 620-662-4458
  • Fax: 620-662-0538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0418951
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number04-18951
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: