Individual
KELLEY R SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
100 HOSPITAL AVE, DU BOIS, PA 15801-1440
(724) 825-0600
Mailing address
145 HOSPITAL AVE, DU BOIS, PA 15801-1462
(814) 375-4000
(814) 375-4011
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
OS012962
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000246632503
UNITED HEALTHCARE
PA
05
—
1011784180001
—
PA
05
—
14928
—
PA
05
—
1539932
—
PA
05
—
158522
—
PA
01
—
410311
UPMC FOR LIFE
PA
01
—
5235361
CIGNA
PA
01
—
7364643
AETNA
PA
01
—
I13444
HEALTHASSURANCE
PA
01
—
SM1641016
SECURITY BLUE
PA
Enumeration date
08/03/2006
Last updated
03/17/2018
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