MEDICARE: SMOOTH 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	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1447068952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMOOTH LLC

Provider Business Mailing Address
First Line	:	4328 FARRAGUT ST
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-2032
Country	:	US
Telephone Number	:	571-406-9220
Fax Number	:

Provider Business Practice Location Address
First Line	:	4328 FARRAGUT ST
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-2032
Country	:	US
Telephone Number	:	571-406-9220
Fax Number	:

Authorized Official
Title or Position	:	CHIEF BUSINESS OFFICER
Name	:	IVAN VESKOV
Credential	:
Telephone Number	:	571-406-9220

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	12/30/2024

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Directions to “SMOOTH LLC ” Practice Location

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