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NPI Code Detail

MEDICARE: TERRY SMITH

MEDICARE: TERRY 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
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1063087526
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY SMITH
Provider Business Mailing Address
First Line : 2126 11TH AVE
Second Line :
City : HUNTINGTON
State : WV
Zip : 25703-2012
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2126 11TH AVE
Second Line :
City : HUNTINGTON
State : WV
Zip : 25703-2012
Country : US
Telephone Number : 304-617-3969
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2021
Last Update Date : 05/26/2021

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Directions to “ TERRY SMITH ” Practice Location

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