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NPI Code Detail

MEDICARE: SAMUEL VINCENT SMITH DO

MEDICARE: SAMUEL VINCENT SMITH DO
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
1207Q00000XFamily Medicine Physician200599NY
2207Q00000XFamily Medicine Physician34007141OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629078860
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL VINCENT SMITH DO
Provider Business Mailing Address
First Line : 17273 STATE ROUTE 104
Second Line : CHILLICOTHE VAMC
City : CHILLICOTHEE
State : OH
Zip : 45601
Country : US
Telephone Number : 740-773-1141
Fax Number :
Provider Business Practice Location Address
First Line : 17273 STATE ROUTE 104
Second Line : CHILLICOTHE VAMC
City : CHILLICOTHEE
State : OH
Zip : 45601-9718
Country : US
Telephone Number : 740-773-1141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2005
Last Update Date : 02/24/2016

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Directions to “ SAMUEL VINCENT SMITH DO” Practice Location

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