Healthcare Provider Details

I. General information

NPI: 1588478424
Provider Name (Legal Business Name): TRAVIS SMARDO SR. CPED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 E CENTENNIAL DR
PITTSBURG KS
66762-6505
US

IV. Provider business mailing address

407 E CENTENNIAL DR
PITTSBURG KS
66762-6505
US

V. Phone/Fax

Practice location:
  • Phone: 620-231-5940
  • Fax: 620-231-5948
Mailing address:
  • Phone: 620-231-5940
  • Fax: 620-231-5948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberCPED4827
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: