MEDICARE: IAN ANDREW 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
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist		AL

General Provider Information

NPI Number	:	1740143338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN ANDREW SMITH

Provider Business Mailing Address
First Line	:	10 HOLLY HILL RD
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36305-1101
Country	:	US
Telephone Number	:	334-200-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	9811 W CHARLESTON BLVD STE 2-641
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7528
Country	:	US
Telephone Number	:	855-864-4322
Fax Number	:

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ IAN ANDREW SMITH ” Practice Location

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