MEDICARE: MICHAEL T 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	332B00000X	Durable Medical Equipment & Medical Supplies		MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043334600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL T SMITH

Provider Business Mailing Address
First Line	:	466 MAIN ST
Second Line	:
City	:	DENNIS PORT
State	:	MA
Zip	:	02639-1319
Country	:	US
Telephone Number	:	508-398-7723
Fax Number	:

Provider Business Practice Location Address
First Line	:	466 MAIN ST
Second Line	:
City	:	DENNIS PORT
State	:	MA
Zip	:	02639-1319
Country	:	US
Telephone Number	:	508-398-7723
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/22/2009

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Directions to “ MICHAEL T SMITH ” Practice Location

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