MEDICARE: MR. JAMES 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
1	374U00000X	Home Health Aide	2180705	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2180705	OTHER	OH	INDEPENDENT PROVIDER

General Provider Information

NPI Number	:	1528121092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES SMITH

Provider Business Mailing Address
First Line	:	3827 CHARBONNETT CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4900
Country	:	US
Telephone Number	:	614-579-5966
Fax Number	:	614-759-8584

Provider Business Practice Location Address
First Line	:	3827 CHARBONNETT CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4900
Country	:	US
Telephone Number	:	614-579-5966
Fax Number	:	614-759-8584

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. JAMES SMITH ” Practice Location

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