MEDICARE: STEPHENY 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	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000	OTHER		LICENSURE

General Provider Information

NPI Number	:	1174039713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHENY SMITH

Provider Business Mailing Address
First Line	:	105 WASHINGTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45217-1317
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 WASHINGTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45217-1317
Country	:	US
Telephone Number	:	513-354-5200
Fax Number	:

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

Provider Enumeration Date	:	12/19/2017
Last Update Date	:	12/19/2017

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Directions to “ STEPHENY SMITH ” Practice Location

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