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NPI Code Detail

MEDICARE: BLACK-SMITH TRIO

MEDICARE: BLACK-SMITH TRIO
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1134621592
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLACK-SMITH TRIO
Provider Business Mailing Address
First Line : PO BOX 468
Second Line :
City : JEANERETTE
State : LA
Zip : 70544-0468
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3915 DARNALL RD
Second Line :
City : NEW IBERIA
State : LA
Zip : 70560-0459
Country : US
Telephone Number : 337-365-1305
Fax Number :
Authorized Official
Title or Position : NURSE PRACTITIONER
Name : SAMONA SMITH DREXLER
Credential : NP
Telephone Number : 337-356-5168
Provider Enumeration Date : 03/01/2018
Last Update Date : 08/21/2019

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