Renaldas Algirdas Smidtas
Organization Active NPI Internal Medicine Physician · Jasper, FL
NPI 1104097963 · NPPES record last updated Jun 30, 2011
Key facts
- NPI
- 1104097963
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- ME0069486 (FL)
- Legal business name
- RENALDAS ALGIRDAS SMIDTAS
- Practice address
- 413 5TH Ave NW
Jasper, FL 32052-7800 - Phone
- (386) 792-0753
- NPI assigned
- Mar 19, 2008
- Organization subpart
- No
Authorized official
- Name
- Mr. Renaldas A Smidtas, MD
- Title
- Owner
- Phone
- (386) 792-0753
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 1
Practitioners 2
-
Renaldas Smidtas, MD
-
Elizabeth Kathryn Newman, ARNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110630000032 | FL | Part B Supplier - Clinic/Group Practice | 4688852254 |
Receives reassigned benefits from 1 practitioner 1 other NPI on this enrollment Practice locations: Jasper, FL; Live Oak, FL |
National Provider Directory
- Tax ID family
- Renaldas Algirdas Smidtas
Locations
1437 Ohio Ave N
Live Oak, FL 32064
Phone (386) 362-5840
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | ME0069486 | FL | Yes |
Addresses
Primary practice location
413 5TH Ave NW
Jasper, FL 32052-7800
Mailing address
413 NW 5TH Ave
Jasper, FL 32052
Phone (386) 792-0753
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103986 | Other | FL | AVMED |
| 110117134 | Other | RAILROAD MEDICARE | |
| 27984 | Other | FL | BCBS |
| 378783400 | Medicaid | FL |
Other providers in Jasper, FL
- Pollock & Pollock Consulting, LLC
- Dwight Pollock
- April Puentes
- Quality Phlebotomy LLC
- Anjana Rana
- Joshua Richardson
- Denise Marie Selph
- Greta R Smidt
- Renaldas Smidtas
- Smith Caring Transport,LLC
All providers in Jasper, FL · Internal Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.