MEDICARE: RK SMITH LLC

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	251E00000X	Home Health Agency	NONE REQUIRED	SC

General Provider Information

NPI Number	:	1043555345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RK SMITH LLC

Provider Business Mailing Address
First Line	:	1691 KATY LN
Second Line	:	SUITE A
City	:	FORT MILL
State	:	SC
Zip	:	29708-8974
Country	:	US
Telephone Number	:	803-547-8400
Fax Number	:	803-547-8402

Provider Business Practice Location Address
First Line	:	1691 KATY LN
Second Line	:	SUITE A
City	:	FORT MILL
State	:	SC
Zip	:	29708-8974
Country	:	US
Telephone Number	:	803-547-8400
Fax Number	:	803-547-8402

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MRS. KAY SMITH
Credential	:
Telephone Number	:	803-547-8400

Provider Enumeration Date	:	11/28/2012
Last Update Date	:	11/28/2012

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