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1073506531

NPI Code Detail

MEDICARE: DR. KENNETH J SMITH MD

MEDICARE: DR. KENNETH J SMITH MD

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	207RH0003X	Hematology & Oncology Physician	041965	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2V5874	OTHER		HEALTHNET
2	010041965CT03	OTHER	CT	ANTHEM BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	041965	OTHER	CT	CONNECTICARE
5	P3157657	OTHER		OXFORD

General Provider Information

NPI Number	:	1073506531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH J SMITH MD

Provider Business Mailing Address
First Line	:	8300 CONSTITUTION AVE. NE
Second Line	:	PRESBYTERIAN ONCOLOGY KASEMAN HOSPITAL
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7613
Country	:	US
Telephone Number	:	505-559-6199
Fax Number	:	505-559-6101

Provider Business Practice Location Address
First Line	:	8300 CONSTITUTION AVE. NE
Second Line	:	PRESBYTERIAN ONCOLOGY KASEMAN HOSPITAL
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7613
Country	:	US
Telephone Number	:	505-559-6199
Fax Number	:	505-559-6101

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	08/12/2011

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Directions to “ DR. KENNETH J SMITH MD” Practice Location

Language	Start Address	Practice Location

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