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NPI Code Detail

MEDICARE: DONALD E. SMITH CRNA

MEDICARE: DONALD E. SMITH CRNA
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
1367500000XCertified Registered Nurse Anesthetist041289062IL
2367500000XCertified Registered Nurse Anesthetist209004059IL

General Provider Information

NPI Number : 1215035050
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONALD E. SMITH CRNA
Provider Business Mailing Address
First Line : 107 CRYSTAL GATE LN
Second Line :
City : GLEN CARBON
State : IL
Zip : 62034-1134
Country : US
Telephone Number : 618-288-9867
Fax Number :
Provider Business Practice Location Address
First Line : 1515 MAIN ST
Second Line :
City : HIGHLAND
State : IL
Zip : 62249-1656
Country : US
Telephone Number : 619-526-5329
Fax Number : 618-526-2291
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 08/23/2022

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