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NPI Code Detail

MEDICARE: MR. MARTIC SMITH CRNA

MEDICARE: MR. MARTIC SMITH CRNA
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
1367500000XCertified Registered Nurse AnesthetistRN082737 AP03943LA

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 : 1851402655
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARTIC SMITH CRNA
Provider Business Mailing Address
First Line : 2701 LONG BRANCH LN
Second Line :
City : SHREVEPORT
State : LA
Zip : 71118-5027
Country : US
Telephone Number : 318-572-5474
Fax Number :
Provider Business Practice Location Address
First Line : 2105 AIRLINE DR
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-3105
Country : US
Telephone Number : 318-549-2011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 09/23/2008

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