NPIMap

Organization Active NPI

Brad D Smith, DO, PA

  • Surgery Physician
  • Idaho Falls, ID
National Provider Identifier
1336246701
Registry record updated Aug 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
O-0374 Issued in ID
Legal business name
BRAD D SMITH, DO, PA
Practice address
2805 Valencia Drive
Idaho Falls, ID 83404
Phone
(208) 542-2787
Fax
(208) 252-6151
NPI assigned
Sep 20, 2006
Last updated
Aug 12, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2010

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

Authorized official

Name
Brad D Smith, D.O.NPI 1144243767
Title
President
Phone
(208) 542-2787

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X O-0374 ID Primary

Addresses

Primary practice location

2805 Valencia Drive
Idaho Falls, ID 83404

Mailing address

3622 Stonebrook LN
Idaho Falls, ID 83404-7903
Phone (208) 542-2787

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281571200000",
    "number": "1336246701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3622 STONEBROOK LN",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047903",
            "telephone_number": "208-542-2787",
            "fax_number": "208-525-6151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 VALENCIA DRIVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83404",
            "telephone_number": "208-542-2787",
            "fax_number": "208-252-6151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAD D SMITH, DO, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2010-08-12",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-542-2787",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "ID",
            "license": "O-0374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2010; 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.