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NPI Code Detail

MEDICARE: MRS. HADEACHA A SMITH

MEDICARE: MRS. HADEACHA A 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
1171M00000XCase Manager/Care Coordinator319274OK

General Provider Information

NPI Number : 1043065428
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HADEACHA A SMITH
Provider Business Mailing Address
First Line : 2621 E 88TH ST APT 437
Second Line :
City : TULSA
State : OK
Zip : 74137-1122
Country : US
Telephone Number : 918-805-3528
Fax Number :
Provider Business Practice Location Address
First Line : 2448 E 81ST ST STE 4460
Second Line :
City : TULSA
State : OK
Zip : 74137-4251
Country : US
Telephone Number : 918-600-2966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2024
Last Update Date : 12/01/2024

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Directions to “ MRS. HADEACHA A SMITH ” Practice Location

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