MEDICARE: AMY SMITH

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
1	171M00000X	Case Manager/Care Coordinator	CERT.	AK

General Provider Information

NPI Number	:	1891362984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY SMITH

Provider Business Mailing Address
First Line	:	PO BOX 1813
Second Line	:
City	:	HOMER
State	:	AK
Zip	:	99603-1813
Country	:	US
Telephone Number	:	907-202-4448
Fax Number	:	907-313-4734

Provider Business Practice Location Address
First Line	:	4103 MATTOX RD APT 8
Second Line	:
City	:	HOMER
State	:	AK
Zip	:	99603-7245
Country	:	US
Telephone Number	:	907-202-4448
Fax Number	:	907-313-4734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	05/20/2026

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