MEDICARE: MR. CHARLES P SMITH R.N.

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	163W00000X	Registered Nurse	140821	MO

General Provider Information

NPI Number	:	1710943626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES P SMITH R.N.

Provider Business Mailing Address
First Line	:	7730 RAYTOWN RD
Second Line	:
City	:	RAYTOWN
State	:	MO
Zip	:	64138-1853
Country	:	US
Telephone Number	:	816-309-2768
Fax Number	:

Provider Business Practice Location Address
First Line	:	7730 RAYTOWN RD
Second Line	:
City	:	RAYTOWN
State	:	MO
Zip	:	64138-1853
Country	:	US
Telephone Number	:	816-309-2768
Fax Number	:

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	07/08/2007

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