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General NPI Number Information
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NPI Number | 1215914445
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Entity Type | Individual
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Provider Name | TRAVIS L SMITH CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 1373 E STATE ROAD 62
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City | MADISON
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State | IN
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Zip | 47250-7328
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Country | US
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Telephone | 812-801-0609
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Fax | 812-801-0276
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Provider Business Mailing Address
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Address Line | DEPT 86236 PO BOX 950195
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City | LOUISVILLE
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State | KY
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Zip | 40295-0195
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Country | US
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Telephone | 502-473-2100
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Fax | 502-456-6461
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 3004523
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License Number State | KY
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