MEDICARE: JORDAN KYLE 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	2279C0205X	Critical Care Registered Respiratory Therapist	RTL.0005794	CO

General Provider Information

NPI Number	:	1932900669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN KYLE SMITH

Provider Business Mailing Address
First Line	:	6259 GALWAY DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-7069
Country	:	US
Telephone Number	:	970-573-0726
Fax Number	:

Provider Business Practice Location Address
First Line	:	6259 GALWAY DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-7069
Country	:	US
Telephone Number	:	970-573-0726
Fax Number	:

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

Provider Enumeration Date	:	03/19/2025
Last Update Date	:	03/19/2025

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