MEDICARE: JORDAN SMITH BC-HIS

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	237700000X	Hearing Instrument Specialist	3501007968	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3501007968	OTHER	MI	HEARING AID SALESPERSON

General Provider Information

NPI Number	:	1447734579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN SMITH BC-HIS

Provider Business Mailing Address
First Line	:	843 W SUMMIT AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49441-4047
Country	:	US
Telephone Number	:	231-755-3920
Fax Number	:

Provider Business Practice Location Address
First Line	:	843 W SUMMIT AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49441-4047
Country	:	US
Telephone Number	:	231-755-3920
Fax Number	:

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

Provider Enumeration Date	:	09/25/2018
Last Update Date	:	09/25/2018

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