Healthcare Provider Details

I. General information

NPI: 1811357130
Provider Name (Legal Business Name): ERIC SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 3RD ST STE 5
RAPID CITY SD
57701-2207
US

IV. Provider business mailing address

401 3RD ST STE 5
RAPID CITY SD
57701-2207
US

V. Phone/Fax

Practice location:
  • Phone: 605-791-5190
  • Fax:
Mailing address:
  • Phone: 605-791-5190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number428H
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: