Healthcare Provider Details

I. General information

NPI: 1912917972
Provider Name (Legal Business Name): STEVE WAYNE SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 STONECREST ROAD SUITE 101
SHELBYVILLE KY
40065
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-5565
  • Fax: 502-633-5154
Mailing address:
  • Phone: 502-489-5730
  • Fax: 502-489-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number29102
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: