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NPI Code Detail

MEDICARE: BRIAN SMITH

MEDICARE: BRIAN 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
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.140897OH
2324500000XSubstance Abuse Rehabilitation Facility140897OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1942602404
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN SMITH
Provider Business Mailing Address
First Line : 4930 ENTERPRISE DR NW
Second Line :
City : WARREN
State : OH
Zip : 44481-8706
Country : US
Telephone Number : 330-787-0955
Fax Number :
Provider Business Practice Location Address
First Line : 4930 ENTERPRISE DR NW
Second Line :
City : WARREN
State : OH
Zip : 44481-8706
Country : US
Telephone Number : 330-787-0955
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2014
Last Update Date : 02/28/2018

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Directions to “ BRIAN SMITH ” Practice Location

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