Provider Demographics
NPI:1295184703
Name:SMITH, SAMANTHA PAIGE (PA-C, ATC)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:PAIGE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E 36TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4168
Mailing Address - Country:US
Mailing Address - Phone:907-562-3060
Mailing Address - Fax:075-623-0619
Practice Address - Street 1:600 E 36TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4168
Practice Address - Country:US
Practice Address - Phone:907-562-3060
Practice Address - Fax:075-623-0619
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1493242255A2300X
MDA00007932255A2300X
AK155981363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1295184703Medicaid