Provider Demographics
NPI:1053427286
Name:CARL E. SMITH, M.D., F.A.A.P., PLLC
Entity type:Organization
Organization Name:CARL E. SMITH, M.D., F.A.A.P., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:606-573-1004
Mailing Address - Street 1:120 PROFESSIONAL LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-2600
Mailing Address - Country:US
Mailing Address - Phone:606-573-1004
Mailing Address - Fax:606-573-0059
Practice Address - Street 1:120 PROFESSIONAL LN
Practice Address - Street 2:SUITE 201
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-2600
Practice Address - Country:US
Practice Address - Phone:606-573-1004
Practice Address - Fax:606-573-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24028174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31000953Medicaid
KY9719Medicare ID - Type Unspecified
KY31000953Medicaid