MEDICARE: JAMES LUBY SMITH RN

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	163W00000X	Registered Nurse	620631	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	620631	OTHER	TX	RN LICENSE

General Provider Information

NPI Number	:	1508018995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES LUBY SMITH RN

Provider Business Mailing Address
First Line	:	819 WATER ST STE 300
Second Line	:
City	:	KERRVILLE
State	:	TX
Zip	:	78028-5330
Country	:	US
Telephone Number	:	830-258-5430
Fax Number	:	830-792-5771

Provider Business Practice Location Address
First Line	:	511 E NORTH ST
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-4247
Country	:	US
Telephone Number	:	830-625-7359
Fax Number	:	830-625-7364

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

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	10/16/2008

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