MEDICARE: MAURE SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency
3	385H00000X	Respite Care

General Provider Information

NPI Number	:	1750107645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURE SMITH

Provider Business Mailing Address
First Line	:	487 WABASH PL
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-2671
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 BLACK JACK CT
Second Line	:
City	:	BLACK JACK
State	:	MO
Zip	:	63033-7101
Country	:	US
Telephone Number	:	314-332-0790
Fax Number	:

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

Provider Enumeration Date	:	11/25/2024
Last Update Date	:	01/16/2026

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Directions to “ MAURE SMITH ” Practice Location

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