| Alan Smith M.d. Llc | |
|
1769 66th St N St Petersburg FL 33710-5537 | |
| (727) 343-2741 | |
| (727) 343-2814 |
| Full Name | Alan Smith M.d. Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1769 66th St N, St Petersburg, Florida |
| Authorized Official Name and Position | Tony Moore (FRONT OFFICE) |
| Authorized Official Contact | 7273432741 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alan Smith M.d. Llc 1769 66th Street N St Petersburg FL 33710 Ph: (727) 343-2741 | Alan Smith M.d. Llc 1769 66th St N St Petersburg FL 33710-5537 Ph: (727) 343-2741 |
| NPI Number | 1194086124 |
|---|---|
| Provider Enumeration Date | 06/06/2012 |
| Last Update Date | 06/26/2012 |
| Medicare PECOS PAC ID | 4688839616 |
|---|---|
| Medicare Enrollment ID | O20120626000158 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194086124 | NPI | - | NPPES |
| 042850700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | ME0044988 (Florida) | Primary |
| Provider Name | Alan A Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821130972 PECOS PAC ID: 9234308909 Enrollment ID: I20110815000401 |
| Provider Name | Jeremy F Smith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265060644 PECOS PAC ID: 3476959446 Enrollment ID: I20231201000281 |
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