Individual
SHANE MICHAEL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
516 W 14TH AVE STE 100, HOLDREGE, NE 68949-1215
(308) 995-4431
(308) 995-3247
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24107
NE
207Q00000X
Family Medicine Physician
37886
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0254656
—
IA
01
—
0638593
MEDIPASS GROUP #
IA
01
—
168505
MEDICARE RURAL HEALTH CLINIC - SANBORN
IA
01
—
168506
MEDICARE RURAL HEALTH CLINIC
IA
01
—
42047
MEDICARE B #
IA
Enumeration date
10/18/2006
Last updated
06/17/2021
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