Healthcare Provider Details

I. General information

NPI: 1003531146
Provider Name (Legal Business Name): MEGAN SMITH RA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN EDWARDS

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6940 OXFORD GETTYSBURG RD
NEW PARIS OH
45347-9030
US

IV. Provider business mailing address

600 WALNUT ST
GREENVILLE OH
45331-1944
US

V. Phone/Fax

Practice location:
  • Phone: 937-437-3333
  • Fax:
Mailing address:
  • Phone: 937-417-8378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number163269
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number163269
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: