MEDICARE: MRS. JAIME RAE SMOLIK 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	363A00000X	Physician Assistant	001440	IA

General Provider Information

NPI Number	:	1295722791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAIME RAE SMOLIK PA-C

Provider Business Mailing Address
First Line	:	PO BOX 4925
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50305-4925
Country	:	US
Telephone Number	:	515-358-0100
Fax Number	:	515-358-0109

Provider Business Practice Location Address
First Line	:	1111 - 6TH AVE - EAST TOWER
Second Line	:	SUITE B1
City	:	DES MOINES
State	:	IA
Zip	:	50314-2613
Country	:	US
Telephone Number	:	515-358-0100
Fax Number	:	515-358-0109

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	02/16/2021

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