MEDICARE: PATRICIA SMITH MT

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	246QM0706X	Medical Technologist

General Provider Information

NPI Number	:	1275917049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA SMITH MT

Provider Business Mailing Address
First Line	:	308 W 2ND NORTH ST
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6538
Country	:	US
Telephone Number	:	843-851-1905
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 W 2ND NORTH ST
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6538
Country	:	US
Telephone Number	:	843-851-1905
Fax Number	:

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

Provider Enumeration Date	:	07/12/2015
Last Update Date	:	07/12/2015

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Directions to “ PATRICIA SMITH MT” Practice Location

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