Healthcare Provider Details

I. General information

NPI: 1073199105
Provider Name (Legal Business Name): QUINN SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 BOYSTOWN HOSPITAL RD
BOYS TOWN NE
68010-7521
US

IV. Provider business mailing address

PO BOX 30292
OMAHA NE
68103-1392
US

V. Phone/Fax

Practice location:
  • Phone: 402-484-6677
  • Fax:
Mailing address:
  • Phone: 800-475-6112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number56902
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number36360
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: