Smith, Mark Samuel

Smith, Mark Samuel is an sole proprietor health care provider with primary practice located at 16000 Johnston Memorial Dr Fourth Floor, Abingdon VA 24211-7659. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Smith, Mark Samuel can be contacted via phone (276) 258-4050.

Contact Information

Primary practice address
16000 Johnston Memorial Dr Fourth Floor Abingdon VA 24211-7659
Phone: (276) 258-4050
Fax: (276) 258-4056
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 2210 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0110004485 Virginia

Profile Details

NPI number 1629321021
LBN Legal business name Smith, Mark Samuel
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 23rd, 2012
Last updated Feb 23rd, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629321021 NPPES
Virginia Other P01334893 RR MEDICARE
Virginia MEDICAID Q000164 RR MEDICARE
Virginia MEDICAID 1629321021 RR MEDICARE

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