| Csmithmd | |
|
820 Jordan St Ste 240 Shreveport LA 71101-4512 | |
| (877) 276-4846 | |
| (318) 252-0560 |
| Full Name | Csmithmd |
|---|---|
| Speciality | Preventive Medicine |
| Location | 820 Jordan St Ste 240, Shreveport, Louisiana |
| Authorized Official Name and Position | Cheryl Austin Smith (PRESIDENT) |
| Authorized Official Contact | 8772764846 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Csmithmd 820 Jordan St Ste 240 Shreveport LA 71101-4512 Ph: (877) 276-4846 | Csmithmd 820 Jordan St Ste 240 Shreveport LA 71101-4512 Ph: (877) 276-4846 |
| NPI Number | 1891822714 |
|---|---|
| Provider Enumeration Date | 02/27/2007 |
| Last Update Date | 02/11/2023 |
| Medicare PECOS PAC ID | 8224933577 |
|---|---|
| Medicare Enrollment ID | O20031201000497 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891822714 | NPI | - | NPPES |
| 1495671 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 023233 (Louisiana) | Secondary |
| 2083A0300X | Preventive Medicine - Addiction Medicine | (* (Not Available)) | Primary |
| Provider Name | Cheryl Austin Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235247230 PECOS PAC ID: 8820993173 Enrollment ID: I20031201000519 |
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