MEDICARE: MADISON SMITH

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	106S00000X	Behavior Technician		KS

General Provider Information

NPI Number	:	1033890504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON SMITH

Provider Business Mailing Address
First Line	:	615 GARFIELD ST
Second Line	:
City	:	EMPORIA
State	:	KS
Zip	:	66801-2420
Country	:	US
Telephone Number	:	405-800-4538
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 GARFIELD ST
Second Line	:
City	:	EMPORIA
State	:	KS
Zip	:	66801-2420
Country	:	US
Telephone Number	:	405-800-4538
Fax Number	:

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

Provider Enumeration Date	:	07/27/2023
Last Update Date	:	07/27/2023

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Directions to “ MADISON SMITH ” Practice Location

Language	Start Address	Practice Location

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