MEDICARE: VITA SMITH MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	A01623	OH

General Provider Information

NPI Number	:	1174700819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VITA SMITH MA

Provider Business Mailing Address
First Line	:	100 N KEEL RIDGE RD
Second Line	:
City	:	HERMITAGE
State	:	PA
Zip	:	16148-3440
Country	:	US
Telephone Number	:	800-471-8592
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N KEEL RIDGE RD
Second Line	:
City	:	HERMITAGE
State	:	PA
Zip	:	16148-3440
Country	:	US
Telephone Number	:	800-471-8592
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	01/24/2008

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Directions to “ VITA SMITH MA” Practice Location

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