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NPI Code Detail

MEDICARE: SMITH CHURCH OBSTETRICS & GYNECOLOGY, PC

MEDICARE: SMITH CHURCH OBSTETRICS & GYNECOLOGY, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1427240845
Entity Type Code : Organization
Provider Name (Legal Business Name) : SMITH CHURCH OBSTETRICS & GYNECOLOGY, PC
Provider Business Mailing Address
First Line : 63 OFFICE PARK DR
Second Line :
City : ROANOKE RAPIDS
State : NC
Zip : 27870-4940
Country : US
Telephone Number : 252-535-4343
Fax Number : 252-308-0977
Provider Business Practice Location Address
First Line : 63 OFFICE PARK DR
Second Line :
City : ROANOKE RAPIDS
State : NC
Zip : 27870-4940
Country : US
Telephone Number : 252-535-4343
Fax Number : 252-308-0977
Authorized Official
Title or Position : OWNER/M.D.
Name : DR. RICHARD W. MINIELLY
Credential : M.D.
Telephone Number : 252-535-4343
Provider Enumeration Date : 08/10/2007
Last Update Date : 02/25/2008

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Directions to “SMITH CHURCH OBSTETRICS & GYNECOLOGY, PC ” Practice Location

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