Smith'S Hometown Family Practice, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

3006073 Issued in KY

Legal business name

SMITH'S HOMETOWN FAMILY PRACTICE, LLC

Practice address

359 Old US Highway 421
Manchester, KY 40962-7538

Phone

(606) 599-8905

Fax

(606) 599-0354

NPI assigned

Sep 4, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shawana M.L. Smith, APRN

Title

Owner

Phone

(606) 599-8905

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409788800000",
    "number": "1275934614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "359 OLD US HIGHWAY 421",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409627538",
            "telephone_number": "606-599-8905",
            "fax_number": "606-599-0354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "359 OLD US HIGHWAY 421",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409627538",
            "telephone_number": "606-599-8905",
            "fax_number": "606-599-0354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMITH'S HOMETOWN FAMILY PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-04",
        "last_updated": "2014-09-04",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "SHAWANA",
        "authorized_official_middle_name": "M.L.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-599-8905",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "KY",
            "license": "3006073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100100870",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11996475",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Serena E Smith, M.S., CCC-SLP
• Sherri Larae Smith, APRN
• Suzann Smith, APRN
• Tara Lee Smith, APRN
• Tonya Smith, PT
• Southeastern Family Drug Center, Inc
• Southeastern Family Drug Center, Inc
• Southeastern Medical Supply LLC
• Amber Sowders, OTR/L
• Dinah Lynn Sowders, SLP

• Clinic/Center in Manchester, KY
• Providers in Manchester, KY by specialty
• Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.