=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306090774
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES A SMITH MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2008
-----------------------------------------------------
Last Update Date | 11/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3673 SOUTHWESTERN BLVD
-----------------------------------------------------
City | ORCHARD PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14127-1732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-662-8080
-----------------------------------------------------
Fax | 716-662-8082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3673 SOUTHWESTERN BLVD
-----------------------------------------------------
City | ORCHARD PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14127-1732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-662-8080
-----------------------------------------------------
Fax | 716-662-8082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JAMES ALBERT SMITH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 716-662-8080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 130257
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------