MEDICARE: JORDAN 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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1841816105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN SMITH

Provider Business Mailing Address
First Line	:	7101 BRYANT IRVIN RD UNIT 34506
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76162-5009
Country	:	US
Telephone Number	:	817-368-1980
Fax Number	:	888-206-1272

Provider Business Practice Location Address
First Line	:	7101 BRYANT IRVIN RD UNIT 34506
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76162-5009
Country	:	US
Telephone Number	:	817-368-1980
Fax Number	:	888-206-1272

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

Provider Enumeration Date	:	06/23/2020
Last Update Date	:	06/23/2020

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Directions to “ JORDAN SMITH ” Practice Location

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