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NPI Code Detail

MEDICARE: MELISSA SMITH, D.O., PSC

MEDICARE: MELISSA SMITH, D.O., PSC
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
12084N0400XNeurology Physician02943KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
102943OTHERKYLICENSE

General Provider Information

NPI Number : 1912186636
Entity Type Code : Organization
Provider Name (Legal Business Name) : MELISSA SMITH, D.O., PSC
Provider Business Mailing Address
First Line : 2222 WINCHESTER AVE STE C
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7847
Country : US
Telephone Number : 606-325-8364
Fax Number : 606-327-8893
Provider Business Practice Location Address
First Line : 2222 WINCHESTER AVE STE C
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7847
Country : US
Telephone Number : 606-325-8364
Fax Number : 606-327-8893
Authorized Official
Title or Position : PRESIDENT
Name : DR. MELISSA SMITH
Credential : D.O.
Telephone Number : 606-325-8364
Provider Enumeration Date : 10/30/2007
Last Update Date : 03/07/2023

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