MEDICARE: DR. JAMES E. SMITH M.D.

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	207P00000X	Emergency Medicine Physician	17973	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00446	OTHER	NE	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548273774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES E. SMITH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9994
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69103-9994
Country	:	US
Telephone Number	:	308-696-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 WEST LEOTA STREET
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-6598
Country	:	US
Telephone Number	:	308-696-8000
Fax Number	:

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	09/12/2008

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