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General NPI Number Information
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NPI Number | 1730456880
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Entity Type | Individual
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Provider Name | JOSH BRIAN SMITH
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Gender | Male
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 02/20/2015
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Provider Practice Location Address
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Address Line | 216 ANAMARIA DR
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City | RAPID CITY
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State | SD
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Zip | 57701-7366
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Country | US
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Telephone | 605-721-4700
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Fax | 605-721-4708
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Provider Business Mailing Address
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Address Line | 13510 EARL CT
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City | RAPID CITY
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State | SD
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Zip | 57702-7406
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Country | US
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Telephone | 586-596-7080
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Fax |
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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 | 4704267742
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CR000872
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License Number State | SD
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