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NPI Code Detail

MEDICARE: JEREMY LYNN SMITH MA., ATC

MEDICARE: JEREMY LYNN SMITH MA., ATC
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
12255A2300XAthletic Trainer

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12255A2300XOTHERCOATHLETIC TRAINER

General Provider Information

NPI Number : 1780634113
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY LYNN SMITH MA., ATC
Provider Business Mailing Address
First Line : 1300 POWELL ST
Second Line :
City : FRUITA
State : CO
Zip : 81521-4106
Country : US
Telephone Number : 970-858-8729
Fax Number :
Provider Business Practice Location Address
First Line : 2020 N 12TH ST
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81501-2914
Country : US
Telephone Number : 970-245-0484
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 07/08/2007

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