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NPI Code Detail

MEDICARE: ANGELA K SMITH PAC

MEDICARE: ANGELA K SMITH PAC
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
1363A00000XPhysician Assistant1106OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780689943
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA K SMITH PAC
Provider Business Mailing Address
First Line : 930 N FLOOD AVE
Second Line :
City : NORMAN
State : OK
Zip : 73069-7642
Country : US
Telephone Number : 405-321-3719
Fax Number : 405-364-3209
Provider Business Practice Location Address
First Line : 6613 N MERIDIAN AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73116-1423
Country : US
Telephone Number : 405-603-8450
Fax Number : 405-603-8455
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 02/04/2011

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