MEDICARE: MR. CURTIS NATHANIEL SMITH SR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	A30448	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00464316	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A30448	OTHER		BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003894213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CURTIS NATHANIEL SMITH SR. MD

Provider Business Mailing Address
First Line	:	PO BOX 1253
Second Line	:
City	:	MOUNT SHASTA
State	:	CA
Zip	:	96067-2617
Country	:	US
Telephone Number	:	530-923-4401
Fax Number	:	530-926-3791

Provider Business Practice Location Address
First Line	:	110 W CASTLE ST
Second Line	:	SUITE 200
City	:	MOUNT SHASTA
State	:	CA
Zip	:	96067-2206
Country	:	US
Telephone Number	:	530-926-4401
Fax Number	:	530-926-3791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	07/23/2012

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