MEDICARE: STACEY A 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	207Q00000X	Family Medicine Physician	44095	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0107063	OTHER	MN	MEDICA #
2	20696	OTHER	MN	NDBS #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1280970	OTHER	MN	AMERICA'S PPO/ARAZ #
5	43G89SM	OTHER	MN	MNBS #
6	0107064	OTHER	MN	MEDICA #
7	142065	OTHER	MN	UCARE #
8	DA9031028234	OTHER	MN	PREFERRED ONE #
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	HP38211	OTHER	MN	HEALTHPARTNERS #
11	MN100045	OTHER	MN	LHS/BANNERHEALTH #

General Provider Information

NPI Number	:	1649210832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY A SMITH MD

Provider Business Mailing Address
First Line	:	211 E MILL ST
Second Line	:
City	:	PELICAN RAPIDS
State	:	MN
Zip	:	56572-4234
Country	:	US
Telephone Number	:	218-863-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 E MILL ST
Second Line	:
City	:	PELICAN RAPIDS
State	:	MN
Zip	:	56572-4234
Country	:	US
Telephone Number	:	218-863-6100
Fax Number	:

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	11/28/2011

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Directions to “ STACEY A SMITH MD” Practice Location

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