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NPI Code Detail

MEDICARE: DR. BETH CAROLYN SMITH

MEDICARE: DR. BETH CAROLYN 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
1390200000XStudent in an Organized Health Care Education/Training Program
22084P0800XPsychiatry PhysicianCC1135MN

General Provider Information

NPI Number : 1669520110
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BETH CAROLYN SMITH
Provider Business Mailing Address
First Line : 8170 33RD AVE
Second Line : MS:21110Q
City : BLOOMINGTON
State : MN
Zip : 55425-4516
Country : US
Telephone Number : 651-552-2600
Fax Number : 651-552-2614
Provider Business Practice Location Address
First Line : 5625 CENEX DR
Second Line :
City : INVER GROVE HEIGHTS
State : MN
Zip : 55077-1724
Country : US
Telephone Number : 651-552-2600
Fax Number : 651-552-2614
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 11/01/2016

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