MEDICARE: SMITHS MEDICAL MD INC

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	332B00000X	Durable Medical Equipment & Medical Supplies	4L862	MN

General Provider Information

NPI Number	:	1619960861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITHS MEDICAL MD INC

Provider Business Mailing Address
First Line	:	1265 GREY FOX RD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-6929
Country	:	US
Telephone Number	:	800-826-9703
Fax Number	:	651-628-7135

Provider Business Practice Location Address
First Line	:	1265 GREY FOX RD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-6929
Country	:	US
Telephone Number	:	800-826-9703
Fax Number	:	651-628-7135

Authorized Official
Title or Position	:	CONTRACTING DEPARTMENT
Name	:	MRS. MICHELLE B FOLEY
Credential	:
Telephone Number	:	651-628-7025

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	08/22/2020

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