=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922072941
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES C SMITH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2006
-----------------------------------------------------
Last Update Date | 09/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8600 NICOLLET AVE S MAIL STOP 31500A
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55420-2824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-887-6600
-----------------------------------------------------
Fax | 952-886-7015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8600 NICOLLET AVE S 31500A
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55420-2824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-887-6600
-----------------------------------------------------
Fax | 952-886-7015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 20246
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------