MEDICARE: CHRISTOPHER 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	171W00000X	Contractor	H12320014	NE

General Provider Information

NPI Number	:	1063206977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER SMITH

Provider Business Mailing Address
First Line	:	936 W 10TH ST
Second Line	:
City	:	LEXINGTON
State	:	NE
Zip	:	68850-1522
Country	:	US
Telephone Number	:	308-325-4427
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 LIBERTY DR
Second Line	:
City	:	LEXINGTON
State	:	NE
Zip	:	68850-1936
Country	:	US
Telephone Number	:	308-325-4427
Fax Number	:

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

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/07/2025

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Directions to “ CHRISTOPHER SMITH ” Practice Location

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