Provider Demographics
NPI:1508951146
Name:SMITH, JANE C (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1569
Mailing Address - Country:US
Mailing Address - Phone:608-324-1000
Mailing Address - Fax:
Practice Address - Street 1:515 22ND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1569
Practice Address - Country:US
Practice Address - Phone:608-324-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI219402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
10897OtherMEDICAID DEAN
390808509OtherWPS
690004890OtherMEDICARE RAILROAD
13900226OtherMEDICARE PART B
WI30291100Medicaid
10897OtherDEAN HEALTH PLAN
90002361OtherWEA INS
30291100OtherHIRSP
390808509OtherCIGNA
390808509OtherCT GENERAL
39080850996OtherUNITY
1004960OtherPHYSICIANS PLUS
260021000OtherMEDICARE RAILROAD