Individual provider Active NPI

Kenneth Wayne Smith III, DO

  • Internal Medicine Physician
  • Norton, VA
National Provider Identifier
1700371044
Registry record updated Jun 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0116032144 Issued in VA
Practice address
96 15TH St NW
Norton, VA 24273-1625
Phone
(276) 679-3488
NPI assigned
Jun 28, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0116032144 VA Primary

Addresses

Primary practice location

96 15TH St NW
Norton, VA 24273-1625

Mailing address

479 Hilton Rd
Gate City, VA 24251-2456
Phone (423) 817-5900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211001000144 TN Practitioner - Internal MedicinePractitioner - Family Practice 7911304100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
0116032144VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmont Medical Associates Inc Internal Medicine CurrentSince Sep 1, 2021 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince Sep 1, 2021 Accepting new patients

Locations

378 Marketplace Blvd
Ste 10
Johnson City, TN 37604
Phone (423) 928-2030

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

96 15th St NW
Norton, VA 24273
Phone (276) 679-0321

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530144000000",
    "number": "1700371044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "479 HILTON RD",
            "city": "GATE CITY",
            "state": "VA",
            "postal_code": "242512456",
            "telephone_number": "423-817-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 15TH ST NW",
            "city": "NORTON",
            "state": "VA",
            "postal_code": "242731625",
            "telephone_number": "276-679-3488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KENNETH",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-28",
        "last_updated": "2018-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0116032144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norton, VA

Sources for this page

Verify at the official NPI Registry.