Active NPI
Patricia Lawrence Smith
- Private Vehicle
- Country Club Hills, IL
National Provider Identifier
1588110092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Private Vehicle
- License
- S530-6927-0828
- Practice address
- 3932 172ND St
Country Club Hills, IL 60478-4638 - Phone
- (773) 842-5958
- Fax
- (708) 991-7584
- NPI assigned
- Aug 26, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Early Intervention Provider Agency | 252Y00000X | |||
| Private Vehicle | 347C00000X | S530-6927-0828 | IL | Primary |
Addresses
Primary practice location
3932 172ND St
Country Club Hills, IL 60478-4638
Mailing address
3932 172ND St
Country Club Hills, IL 60478-4638
Phone (773) 842-5958
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 |
|---|---|---|---|
| S530-6927-0828 | IL | MD | Private Vehicle |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472169600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695772800000",
"number": "1588110092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3932 172ND ST",
"city": "COUNTRY CLUB HILLS",
"state": "IL",
"postal_code": "604784638",
"telephone_number": "773-842-5958",
"fax_number": "708-991-7584"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3932 172ND ST",
"city": "COUNTRY CLUB HILLS",
"state": "IL",
"postal_code": "604784638",
"telephone_number": "773-842-5958",
"fax_number": "708-991-7584"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "PATRICIA",
"middle_name": "LAWRENCE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-08-26",
"last_updated": "2023-09-27",
"certification_date": "2023-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "252Y00000X",
"taxonomy_group": "",
"desc": "Early Intervention Provider Agency",
"state": null,
"license": null,
"primary": false
},
{
"code": "347C00000X",
"taxonomy_group": "",
"desc": "Private Vehicle",
"state": "IL",
"license": "S530-6927-0828",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Country Club Hills, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.