Healthcare Provider Details

I. General information

NPI: 1437862489
Provider Name (Legal Business Name): MATTHEW SMILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

IV. Provider business mailing address

1019 BIG SANDY RIVER RD
FORT GAY WV
25514-7021
US

V. Phone/Fax

Practice location:
  • Phone: 855-446-5937
  • Fax:
Mailing address:
  • Phone: 304-521-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010459RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: