Healthcare Provider Details

I. General information

NPI: 1124507736
Provider Name (Legal Business Name): SMITH MANAGEMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 STATE HIGHWAY 14 W STE A
CLEVER MO
65631
US

IV. Provider business mailing address

PO BOX 172678
SPARTANBURG SC
29301-0064
US

V. Phone/Fax

Practice location:
  • Phone: 417-583-2595
  • Fax: 417-583-2097
Mailing address:
  • Phone: 864-582-1216
  • Fax: 855-971-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROY MEIDINGER
Title or Position: VICE PRESIDENT
Credential:
Phone: 980-422-3854