Healthcare Provider Details

I. General information

NPI: 1184353963
Provider Name (Legal Business Name): CARL SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4543 BUFORT BLVD
HUBER HEIGHTS OH
45424-5585
US

IV. Provider business mailing address

4543 BUFORT BLVD
HUBER HEIGHTS OH
45424-5585
US

V. Phone/Fax

Practice location:
  • Phone: 937-267-0909
  • Fax:
Mailing address:
  • Phone: 937-267-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: