MEDICARE: 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	171M00000X	Case Manager/Care Coordinator		FL

General Provider Information

NPI Number	:	1730933631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES SMITH

Provider Business Mailing Address
First Line	:	2150 SANDY HOOK
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1355
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 SANDY HOOK
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1355
Country	:	US
Telephone Number	:	863-220-4602
Fax Number	:

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

Provider Enumeration Date	:	04/16/2024
Last Update Date	:	04/16/2024

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