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BRUCE SYLVESTER SMITH MD LLC NPI 1568634806


NPI Information

NPI: 1568634806
Provider Name: BRUCE SYLVESTER SMITH MD LLC
Classification: Specialist - 174400000X
Entity Type: Organization
Address:
104 W 6TH ST
SUITE 206
STREATOR, IL
ZIP 61364
Phone: (815) 672-1610
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BRUCE SYLVESTER SMITH MD LLC is a specialist in Streator, IL. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. BRUCE SYLVESTER SMITH MD LLC NPI is 1568634806. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

104 W 6TH ST
SUITE 206
STREATOR, IL
ZIP 61364-899
Phone: (815) 672-1610
Fax: (815) 672-1615

The provider's authorized official is Bruce Sylvester Smith .
The authorized official title is Owner and has the following contact phone number (815) 672-1610.

The enumeration date for this NPI number is 3/27/2008 and was last updated on 3/27/2008.


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
1174400000XSpecialistILLINOISYes

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
1213399MEDICARE UPIN

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: 5/5/2024

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