MEDICARE: BARRY L. SMELTZER 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	363AS0400X	Surgical Physician Assistant	085001810	IL
2	363AM0700X	Medical Physician Assistant	TX07115	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	209119	OTHER	IL	MEDICARE PTAN LOCALITY 16
2	209118	OTHER	IL	MEDICARE PTAN LOCALITY 15

General Provider Information

NPI Number	:	1538116884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY L. SMELTZER PA-C

Provider Business Mailing Address
First Line	:	155 E SONTERRA BLVD
Second Line	:	SUITE 201
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3987
Country	:	US
Telephone Number	:	210-369-9856
Fax Number	:	210-570-8020

Provider Business Practice Location Address
First Line	:	155 E SONTERRA BLVD
Second Line	:	SUITE 201
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3987
Country	:	US
Telephone Number	:	210-369-9856
Fax Number	:	210-570-8020

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	04/09/2015

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Directions to “ BARRY L. SMELTZER PA-C” Practice Location

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