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General NPI Number Information
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NPI Number | 1538571328
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Entity Type | Organization
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Legal Business Name | SMITH VEIN INSTITUTE, LLC
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Dates
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Enumeration Date | 05/28/2014
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 7515 FREDLE DR
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City | PAINESVILLE
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State | OH
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Zip | 44077-9406
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Country | US
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Telephone | 440-853-8208
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Fax | 216-370-3249
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Provider Business Mailing Address
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Address Line | 7515 FREDLE DR
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City | PAINESVILLE
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State | OH
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Zip | 44077-9406
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Country | US
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Telephone | 440-853-8208
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Fax | 216-370-3249
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID G SMITH
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Credential | M.D.
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Telephone | 440-853-8208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35.064610
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License Number State | OH
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