Healthcare Provider Details

I. General information

NPI: 1255792792
Provider Name (Legal Business Name): BETHANY MELVA SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 N COLUMBUS ST SUITE 250
LANCASTER OH
43130-8185
US

IV. Provider business mailing address

2405 N COLUMBUS ST SUITE 250
LANCASTER OH
43130-8185
US

V. Phone/Fax

Practice location:
  • Phone: 740-654-6213
  • Fax: 740-654-3346
Mailing address:
  • Phone: 740-654-6213
  • Fax: 740-654-3346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004520RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: