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NPI Code Detail

MEDICARE: ROSCOE SMITH IV

MEDICARE: ROSCOE SMITH IV
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
1106S00000XBehavior TechnicianS530720040480FL

General Provider Information

NPI Number : 1871393413
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSCOE SMITH IV
Provider Business Mailing Address
First Line : 1350 MARDEN RD APT 421
Second Line :
City : APOPKA
State : FL
Zip : 32703-6992
Country : US
Telephone Number : 407-613-1207
Fax Number :
Provider Business Practice Location Address
First Line : 601 S LAKE DESTINY RD STE 350
Second Line :
City : MAITLAND
State : FL
Zip : 32751-7222
Country : US
Telephone Number : 407-647-6555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2025
Last Update Date : 03/19/2026

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Directions to “ ROSCOE SMITH IV ” Practice Location

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