Active NPI
Mary Ellen Smith, LMT
- Community Health Worker
- Gassaway, WV
National Provider Identifier
1194963629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 2008-2502
- Practice address
- 847 State St
Gassaway, WV 26624-9303 - Phone
- (304) 364-8113
- NPI assigned
- Jan 21, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 2008-2502 | WV | Primary |
Addresses
Primary practice location
847 State St
Gassaway, WV 26624-9303
Mailing address
RR 1 Box 108
Frametown, WV 26623-9740
Phone (304) 364-5571
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2008-2502 | WV | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294704000000",
"number": "1194963629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "RR 1 BOX 108",
"city": "FRAMETOWN",
"state": "WV",
"postal_code": "266239740",
"telephone_number": "304-364-5571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "847 STATE ST",
"city": "GASSAWAY",
"state": "WV",
"postal_code": "266249303",
"telephone_number": "304-364-8113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "MARY",
"middle_name": "ELLEN",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-01-21",
"last_updated": "2011-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "WV",
"license": "2008-2502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gassaway, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.