MEDICARE: RUSSELL A. SMITH, MD PC

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	261QH0100X	Health Service Clinic/Center	4938616-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588843536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSSELL A. SMITH, MD PC

Provider Business Mailing Address
First Line	:	9600 S 1300 E
Second Line	:	300
City	:	SANDY
State	:	UT
Zip	:	84094-3766
Country	:	US
Telephone Number	:	801-571-7777
Fax Number	:	801-523-1848

Provider Business Practice Location Address
First Line	:	9600 S 1300 E
Second Line	:	300
City	:	SANDY
State	:	UT
Zip	:	84094-3766
Country	:	US
Telephone Number	:	801-571-7777
Fax Number	:	801-523-1848

Authorized Official
Title or Position	:	PRES
Name	:	DR. RUSSELL A SMITH
Credential	:	MD
Telephone Number	:	801-571-7777

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	04/04/2008

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