Healthcare Provider Details

I. General information

NPI: 1750812293
Provider Name (Legal Business Name): SMITH FAMILY HEALTHCARE, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 PINECREST DR
GALLIPOLIS OH
45631-1347
US

IV. Provider business mailing address

254 PINECREST DR
GALLIPOLIS OH
45631-1347
US

V. Phone/Fax

Practice location:
  • Phone: 740-578-4824
  • Fax: 740-578-4821
Mailing address:
  • Phone: 740-578-4824
  • Fax: 740-578-4821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberRN251827/NP06403
License Number StateOH

VIII. Authorized Official

Name: DIANNA KAY SMITH
Title or Position: PARTNER/NURSE PRACTITIONER
Credential:
Phone: 740-578-4824