Healthcare Provider Details

I. General information

NPI: 1821385485
Provider Name (Legal Business Name): RICHARD SMILLIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CAMPUS VIEW BLVD STE 100
COLUMBUS OH
43235-8628
US

IV. Provider business mailing address

100 E CAMPUS VIEW BLVD SUITE 100
COLUMBUS OH
43235
US

V. Phone/Fax

Practice location:
  • Phone: 614-340-7747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number4301098671
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301098671
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number35.130542
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: