MEDICARE: WAIDE L SMART RRT

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	227900000X	Registered Respiratory Therapist

General Provider Information

NPI Number	:	1710097522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAIDE L SMART RRT

Provider Business Mailing Address
First Line	:	3243 NW 22 AVE
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-2158
Country	:	US
Telephone Number	:	954-579-7467
Fax Number	:

Provider Business Practice Location Address
First Line	:	3243 NW 22ND AVE
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-6497
Country	:	US
Telephone Number	:	954-579-7467
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/09/2007

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