Basic Information
| Provider Information | |||||||||
| NPI: | 1205837069 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635283 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593410288 | ||||||||
| FaxNumber: | 8593417482 | ||||||||
| Practice Location | |||||||||
| Address1: | 334 THOMAS MORE PKWY | ||||||||
| Address2: | |||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410173464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593410288 | ||||||||
| FaxNumber: | 8593417482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 09/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 41585 | KY | N | Other Service Providers | Specialist | 207R00000X | 41585 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000560926 | 01 | ANTHEM | OTHER | 0420604 | 01 | OH | UNITED HEALTH CARE | OTHER | 0829072 | 05 | OH | MEDICAID | 7100044490 | 05 | KY | MEDICAID | 634925 | 01 | OH | AETNA | OTHER | P00922874 | 01 | KY | RAIL ROAD MEDICARE | OTHER | 000000008876 | 01 | OH | ANTHEM | OTHER |