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NPI Code Detail

MEDICARE: BRIAN K SMITH CRNA

MEDICARE:   BRIAN K 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 Anesthetist2012025986MO

General Provider Information

NPI Number : 1871592709
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN K SMITH CRNA
Provider Business Mailing Address
First Line : PO BOX 4046
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65808-4046
Country : US
Telephone Number : 417-269-5712
Fax Number : 417-269-7567
Provider Business Practice Location Address
First Line : 801 N LINCOLN AVE
Second Line :
City : MONETT
State : MO
Zip : 65708-1641
Country : US
Telephone Number : 417-235-3144
Fax Number : 417-354-1177
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 03/30/2018

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