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NPI Code Detail

MEDICARE: MR. JAMES ERNEST SMITH P.A.-C

MEDICARE: MR. JAMES ERNEST SMITH P.A.-C
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
1363AM0700XMedical Physician Assistant2653NV
2363AM0700XMedical Physician AssistantTP7937AZ

General Provider Information

NPI Number : 1205867116
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES ERNEST SMITH P.A.-C
Provider Business Mailing Address
First Line : 2450 E JOY LN
Second Line :
City : FORT MOHAVE
State : AZ
Zip : 86426-6643
Country : US
Telephone Number : 909-896-1990
Fax Number : 928-289-8036
Provider Business Practice Location Address
First Line : 500 INDIANA AVE
Second Line :
City : WINSLOW
State : AZ
Zip : 86047-2169
Country : US
Telephone Number : 928-289-8157
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 11/26/2025

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