MEDICARE: MR. LINCOLN STEPHEN SMITH PA-C

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	363AM0700X	Medical Physician Assistant	PA60577633	WA
2	363A00000X	Physician Assistant	OA61063409	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA60577633	OTHER	WA	WASHINGTON STATE PA LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225411291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LINCOLN STEPHEN SMITH PA-C

Provider Business Mailing Address
First Line	:	4550 FAUNTLEROY WAY SW STE 200
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-3471
Country	:	US
Telephone Number	:	206-933-1041
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 FAUNTLEROY WAY SW STE 200
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-3471
Country	:	US
Telephone Number	:	206-933-1041
Fax Number	:

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

Provider Enumeration Date	:	07/08/2015
Last Update Date	:	12/09/2020

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