MEDICARE: ANDREA 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	1744P3200X	Prosthetics Case Management		IN

General Provider Information

NPI Number	:	1619454493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA SMITH

Provider Business Mailing Address
First Line	:	3619 N ARLINGTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-1806
Country	:	US
Telephone Number	:	317-542-1393
Fax Number	:

Provider Business Practice Location Address
First Line	:	3619 N ARLINGTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-1806
Country	:	US
Telephone Number	:	317-542-1393
Fax Number	:

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

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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Directions to “ ANDREA SMITH ” Practice Location

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