MEDICARE: KEVIN S SMITH MD

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	207R00000X	Internal Medicine Physician	036-082153	IL
2	208M00000X	Hospitalist Physician	39134	KY
3	207R00000X	Internal Medicine Physician	39134	KY
4	207R00000X	Internal Medicine Physician	01051932A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	214881	OTHER	IL	MEDICARE GROUP PTAN
2	P00267326	OTHER	KY	RAILROAD MEDICARE - NICC
3	P00838098	OTHER	IN	RAILROAD MEDICARE - NICC
7	P00272398	OTHER	KY	RAILROAD MEDICARE - NICC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	049238	OTHER	SIHO
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	000000382064	OTHER	ANTHEM

General Provider Information

NPI Number	:	1619932993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN S SMITH MD

Provider Business Mailing Address
First Line	:	PO BOX 950202
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40295-0202
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5116

Provider Business Practice Location Address
First Line	:	1930 BISHOP LN
Second Line	:	STE 1017
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-1921
Country	:	US
Telephone Number	:	502-272-5064
Fax Number	:	502-272-5339

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	08/15/2024

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Directions to “ KEVIN S SMITH MD” Practice Location

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