MEDICARE: MARK 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1255284758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK SMITH

Provider Business Mailing Address
First Line	:	5308 RIDGE RD
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-8907
Country	:	US
Telephone Number	:	501-681-6181
Fax Number	:

Provider Business Practice Location Address
First Line	:	5308 RIDGE RD
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-8907
Country	:	US
Telephone Number	:	501-681-6181
Fax Number	:

Authorized Official
Title or Position	:	BILLING
Name	:	AARON SILVER
Credential	:
Telephone Number	:	972-369-7714

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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