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NPI Code Detail

MEDICARE: TYRA SMITH

MEDICARE: TYRA SMITH
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
1374U00000XHome Health AideOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20092134OTHEROHPROVIDER NUMBER

General Provider Information

NPI Number : 1497164917
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYRA SMITH
Provider Business Mailing Address
First Line : 3012 CARSKADDON AVE APT 1
Second Line :
City : TOLEDO
State : OH
Zip : 43606-6608
Country : US
Telephone Number : 419-932-5318
Fax Number :
Provider Business Practice Location Address
First Line : 3012 CARSKADDON AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43606-6607
Country : US
Telephone Number : 419-932-5318
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2014
Last Update Date : 05/22/2020

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Directions to “ TYRA SMITH ” Practice Location

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