MEDICARE: SMILEY HEALTH GROUP LLC

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1316384464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILEY HEALTH GROUP LLC

Provider Business Mailing Address
First Line	:	5780 HYDE PARK DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-3031
Country	:	US
Telephone Number	:	334-215-7969
Fax Number	:

Provider Business Practice Location Address
First Line	:	5780 HYDE PARK DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-3031
Country	:	US
Telephone Number	:	334-215-7969
Fax Number	:

Authorized Official
Title or Position	:	NCMA, PPA, OWNER
Name	:	MS. CORNELIA SMILEY
Credential	:
Telephone Number	:	334-215-7969

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	05/30/2013

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