Basic Information
| Provider Information | |||||||||
| NPI: | 1619488152 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 411895 DEPT 109 | ||||||||
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| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136424900 | ||||||||
| FaxNumber: | 9133810979 | ||||||||
| Practice Location | |||||||||
| Address1: | 9100 W 74TH ST | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662044004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136322230 | ||||||||
| FaxNumber: | 9137489319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 140612 | KS | N | Nursing Service Providers | Registered Nurse | 367500000X | 557553 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.