EMMETT SMITH JR. (NPI# 1649694936) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649694936 |
| Entity Type | Individual |
| Full Name | EMMETT SMITH JR. |
| Practice Address |
18660 Graphic Dr Suite 100 Tinley Park IL 60477-6260 |
| Practice Telephone | 7082632000 |
| Practice Fax Number | 7082632024 |
| Mailing Telephone | 7082632000 |
| Mailing Fax Number | 7082632024 |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2014-02-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | SURGICAL ASSISTANT | 238000399 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376521112 | Emmett Ward Smith | Dentist | 3150 Zelda Ct, Montgomery, AL 36106-2607 | 2006-01-03 |
| 1104815992 | Emmett Donald Smith | Optometrist | 136 North St, Cleveland, MS 38732-2744 | 2005-10-14 |
| Street Address |
18660 GRAPHIC DR SUITE 100 |
| City | TINLEY PARK |
| State | IL |
| Zip Code | 60477-6260 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720165723 | Suburban Surgical Facility | Clinic/Center | 18660 Graphic Dr, Ste 100, Tinley Park, IL 60477-6260 | 2006-11-01 |
| 1124396163 | William James Sullivan | Specialist/Technologist | 18660 Graphic Dr, Tinley Park, IL 60477-6257 | 2011-12-05 |
| 1407162720 | Tinley Park Open Mri&imaging Center Ltd | Clinic/Center | 18660 Graphic Dr, Suite 101, Tinley Park, IL 60477-6257 | 2010-08-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013522366 | Joshua Gruenke | Physical Therapist | 17129 S. Harlem Avenue, Tinley Park, IL 60477 | 2020-09-14 |
| 1881229656 | Sherrie Lynn Tsang | Massage Therapist | 7925 West 171st Street, Tinley Park, IL 60477 | 2020-03-11 |
| 1437782117 | Du Page Medical Group Ltd | Durable Medical Equipment & Medical Supplies | 17129 S Harlem Ave. Ste B3, Tinley Park, IL 60477 | 2020-02-20 |
| 1356998561 | Rasa Vaskeviciute | Physical Therapist | 17129 So Harlem, Tinley Park, IL 60477 | 2019-08-22 |
| 1538728258 | Michelle Anne Wisen | Physical Therapy Assistant | 17129 South Harlem, Suite B3, Tinley Park, IL 60477 | 2019-06-06 |
| 1073006151 | Danielle Lyon | Counselor | 6801 West 180th Court, Tinley Park, IL 60477 | 2018-06-13 |
| 1316445794 | Yvonne Tran | Physical Therapist | 17129 S Harlem Ave, Tinley Park, IL 60477 | 2018-01-31 |
| 1326574591 | Nicholas Barker | Chronic Disease Hospital | 7859 Joliet Drive North, Tinley Park, IL 60477 | 2017-05-10 |
| 1982063632 | Nicole Kristine Demarco | Specialist/Technologist | 16317 Clark Ln, Tinley Park, IL 60477 | 2016-02-22 |
| 1376900571 | Ucp Seguin Greater Chicago | Foster Care Agency | 7550 W. 183rd, Tinley Park, IL 60477 | 2016-01-20 |
| Find all providers in zip 60477 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679687164 | George J Cloud Jr. | Physician Assistant | 6850 Centennial Dr, Tinley Park, IL 60477-1653 | 2006-08-19 |
| 1780055285 | Jessica Stoeberl | Physician Assistant | 6703 W 159th Street, Suite 110, Tinley Park, IL 60477 | 2015-10-12 |
| 1982989687 | Courtney Ann Schmidt | Physician Assistant | 17495 La Grange Rd, Tinley Park, IL 60487-7581 | 2011-10-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477169522 | Priority Assist Pllc | Physician Assistant | 48 Glenda Ln, Plano, IL 60545-9652 | 2020-09-23 |
| 1154944478 | Diana Goldak | Physician Assistant | 3855 N Parkway Dr Apt 3a, Northbrook, IL 60062-7218 | 2020-05-20 |
| 1033742580 | Colleen Courtney | Physician Assistant | 218 S Driftwood Trl, Mchenry, IL 60050-5454 | 2020-02-12 |
| 1326678962 | Nina Kodros | Physician Assistant | 301 Madison St Ste 280, Joliet, IL 60435-6672 | 2020-01-23 |
| 1689218190 | Jennifer Richman | Physician Assistant | 1890 Silver Cross Blvd Ste 410, New Lenox, IL 60451-9547 | 2019-10-29 |
| 1710547625 | Nadia Khan | Physician Assistant | 4543 N Malden St Apt 1s, Chicago, IL 60640-5687 | 2019-06-13 |
| 1962065516 | Jorge Mantilla | Physician Assistant | 5540 N Kimball Ave Apt 3e, Chicago, IL 60625-4674 | 2019-04-18 |
| 1013479955 | Leah Rae Prager | Physician Assistant | 4400 W. 95th St., Attn: Pediatric General Surgery, Oak Lawn, IL 60453 | 2019-04-01 |
| 1770041949 | Laura Ann Ryan | Physician Assistant | 840 S Wood St Ste 417, Chicago, IL 60612-4325 | 2019-03-06 |
| 1548739782 | Helen Finke | Physician Assistant | 880 W Central Rd Ste 3300, Arlington Heights, IL 60005-2366 | 2018-11-16 |
| Find all providers with the same taxonomy | ||||
| City | TINLEY PARK |
| Zip Code | 60477 |
Please comment or provide details below to improve the information on EMMETT SMITH JR..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.