Healthcare Provider Details

I. General information

NPI: 1487015772
Provider Name (Legal Business Name): VANIS SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 MAIN ST
COLUMBIA SC
29201-2818
US

IV. Provider business mailing address

1624 MAIN ST
COLUMBIA SC
29201-2818
US

V. Phone/Fax

Practice location:
  • Phone: 803-454-0364
  • Fax:
Mailing address:
  • Phone: 803-454-0364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number5012
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: