Provider Demographics
NPI:1588877690
Name:SMITH, GREGORY JASON
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JASON
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:52715 WODA DR
Mailing Address - City:BEALLSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43716
Mailing Address - Country:US
Mailing Address - Phone:740-926-2023
Mailing Address - Fax:
Practice Address - Street 1:52715 WODA DR
Practice Address - Street 2:
Practice Address - City:BEALLSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43716
Practice Address - Country:US
Practice Address - Phone:740-926-2023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2395920OtherINDEPENDENT PROVIDER