Charles Smith

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Practice address

905 Holiday Dr
Ardmore, OK 73401-1216

Phone

(580) 226-5003

NPI assigned

Sep 29, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Southern Oklahoma Treatment Services, Inc.

  • Methadone Clinic
  • Ardmore, OK
  • NPI 1083786719

  Mental Health (Including Community Mental Health Center)

  NPD (past)

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

{
    "created_epoch": "1695945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1952181844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 HOLIDAY DR",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 HOLIDAY DR",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011216",
            "telephone_number": "580-226-5003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CHARLES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-09-29",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edward Clyde Skidmore Jr., R.S.S.
• Small Properties LC (Ardmore Orthopedic Center)
• Neal Charles Small, M.D.
• Stephen F. Smalley, D.D.S.
• Alicia Smith
• Derek Smith, APRN-CNP
• Janet Diane Smith, D.PH.
• Jayli Smith
• Jessica Lynn Smith
• Jody Lee Smith, D.O.

• Mental Health Clinic/Center (Including Community Mental Health Center) in Ardmore, OK
• Providers in Ardmore, OK by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; 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.