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NPI Code Detail

MEDICARE: JILL ELAINE SMITH PA-C

MEDICARE: JILL ELAINE SMITH PA-C
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
1363AM0700XMedical Physician AssistantPA12144TX
2363A00000XPhysician AssistantPA12144TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659853356
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL ELAINE SMITH PA-C
Provider Business Mailing Address
First Line : PO BOX 911230
Second Line :
City : DALLAS
State : TX
Zip : 75391-1242
Country : US
Telephone Number : 972-997-8000
Fax Number : 972-234-2987
Provider Business Practice Location Address
First Line : 910 E HOUSTON ST STE 100
Second Line :
City : TYLER
State : TX
Zip : 75702-8363
Country : US
Telephone Number : 903-579-9800
Fax Number : 903-526-4463
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2018
Last Update Date : 11/09/2021

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Directions to “ JILL ELAINE SMITH PA-C” Practice Location

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