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NPI Code Detail

MEDICARE: DR. CHAD J. SMITH D.O.

MEDICARE: DR. CHAD J. SMITH D.O.
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
1207Q00000XFamily Medicine Physician2003015262MO

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 : 1982600615
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHAD J. SMITH D.O.
Provider Business Mailing Address
First Line : PO BOX 955534
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63195-0001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18800 SCHNUCKS DR STE B
Second Line :
City : WARRENTON
State : MO
Zip : 63383-1121
Country : US
Telephone Number : 636-456-3413
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 06/12/2024

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