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NPI Code Detail

MEDICARE: MADELINE SHELBY SMITH

MEDICARE: MADELINE SHELBY SMITH
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
1246Z00000XOther Specialist/Technologist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11111111111OTHERNOTAPPLICABLE

General Provider Information

NPI Number : 1639823206
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELINE SHELBY SMITH
Provider Business Mailing Address
First Line : 111 BOLAND ST STE 211
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-1265
Country : US
Telephone Number : 817-529-8485
Fax Number :
Provider Business Practice Location Address
First Line : 111 BOLAND ST STE 211
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-1265
Country : US
Telephone Number : 817-529-8485
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2022
Last Update Date : 02/11/2022

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Directions to “ MADELINE SHELBY SMITH ” Practice Location

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