Healthcare Provider Details

I. General information

NPI: 1942024138
Provider Name (Legal Business Name): ADAM JOSEPH SMART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3288 E PINE AVE
MERIDIAN ID
83642-5922
US

IV. Provider business mailing address

3288 E PINE AVE
MERIDIAN ID
83642-5922
US

V. Phone/Fax

Practice location:
  • Phone: 208-888-8887
  • Fax:
Mailing address:
  • Phone: 208-888-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: