MEDICARE: MECCA K MAXEY-SMARTT 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	207Q00000X	Family Medicine Physician	036119520	IL
2	207Q00000X	Family Medicine Physician	01063955A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	266430767	OTHER	IN	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1629255377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MECCA K MAXEY-SMARTT MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9757 WESTPOINT DR STE 100
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-3329
Country	:	US
Telephone Number	:	971-962-8893
Fax Number	:	317-944-0470

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

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	02/27/2023

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Directions to “ MECCA K MAXEY-SMARTT MD” Practice Location

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