Healthcare Provider Details

I. General information

NPI: 1093033847
Provider Name (Legal Business Name): SMITH CENTER FOR CARDIOVASCULAR WELLNESS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CREEKVIEW CT
GREENVILLE SC
29615-4800
US

IV. Provider business mailing address

45 CREEKVIEW CT
GREENVILLE SC
29615-4800
US

V. Phone/Fax

Practice location:
  • Phone: 864-234-7474
  • Fax: 864-234-0778
Mailing address:
  • Phone: 864-234-7474
  • Fax: 864-234-0778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number13551
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number13551
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number13551
License Number StateSD
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number13551
License Number StateSC

VIII. Authorized Official

Name: DR. DESMOND ERNESTO SMITH
Title or Position: OWNER/OPERATOR
Credential: M.D.
Phone: 864-552-0275