MR. KENNETH A SMITH MD NPI 1003907304

NPI Information

NPI: 1003907304
Provider Name: MR. KENNETH A SMITH, MD
Classification: Internal Medicine - 207RR0500X
Entity Type: Individual

Specialization: Rheumatology

PECOS Registration: Yes

Address:
1234 EAST DUPONT ROAD
SUITE 5
FORT WAYNE, IN
ZIP 46825
Phone: (260) 489-1666
Get Directions

MR. Kenneth A Smith, MD is a rheumatology internal medicine in Fort Wayne, IN. The provider is an internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and collagen diseases. MR. Kenneth A Smith, MD NPI is 1003907304. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1234 EAST DUPONT ROAD
SUITE 5
FORT WAYNE, IN
ZIP 46825
Phone: (260) 489-1666
Fax: (260) 489-3255

The NPI 1003907304 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/28/2006 and was last updated on 8/3/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RR0500X	Internal Medicine	Rheumatology	01022346	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000000637485	OTHER	INDIANA	ANTHEM
2	000000006713	OTHER		M PLAN
3	200092670	MEDICAID	INDIANA
4	263950A	MEDICARE PIN	INDIANA
5	4351567	OTHER		AETNA
6	C24505	MEDICARE UPIN
7	1866	OTHER		PHP
8	724110B	MEDICARE ID-TYPE UNSPECIFIED	INDIANA
9	000000206530	OTHER		ANTHEM
10	P00786840	OTHER	INDIANA	R.R. MEDICARE
11	100108770A	MEDICAID	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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