Healthcare Provider Details

I. General information

NPI: 1003768771
Provider Name (Legal Business Name): GREGG THOMAS SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 DORR ST
TOLEDO OH
43607-3423
US

IV. Provider business mailing address

2824 CHESTNUT ST UPPR
TOLEDO OH
43608-2462
US

V. Phone/Fax

Practice location:
  • Phone: 419-407-5342
  • Fax: 419-407-5371
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberQMHS
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.006965
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: