Roger Dale Smith
Individual provider Active NPI Homemaker · Caruthersville, MO
NPI 1487868196 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1487868196
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Homemaker 376J00000X
- Practice address
- 509 Ward Ave
Caruthersville, MO 63830-1661 - Phone
- (573) 333-5777
- Fax
- (573) 333-2545
- NPI assigned
- May 10, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cotoneaster Incorporated | Past | Accepting new patients | |
| Cotoneaster CDS,LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Homemaker | 376J00000X | Yes |
Addresses
Primary practice location
509 Ward Ave
Caruthersville, MO 63830-1661
Mailing address
509 Ward Ave
Caruthersville, MO 63830-1661
Phone (573) 333-5777
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 268949609 | Medicaid | MO | |
| 858949605 | Medicaid | MO | |
| 288949605 | Medicaid | MO |
Other providers in Caruthersville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.