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NPI Code Detail

MEDICARE: JOHN SMETANA

MEDICARE: JOHN SMETANA
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
1363A00000XPhysician AssistantPAC0572ND

General Provider Information

NPI Number : 1164851457
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN SMETANA
Provider Business Mailing Address
First Line : P.O. BOX 391
Second Line : 825 S MAIN ST
City : TONOPAH
State : NV
Zip : 89049-0391
Country : US
Telephone Number : 775-482-6233
Fax Number : 775-482-2480
Provider Business Practice Location Address
First Line : 1308 ELBOWOOD LN
Second Line :
City : BISMARCK
State : ND
Zip : 58503-5712
Country : US
Telephone Number : 701-751-8260
Fax Number : 701-751-2463
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2013
Last Update Date : 01/28/2026

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