Provider Demographics
NPI:1700830056
Name:SMYTH, ALAN (PA-C)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:SMYTH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:PAWNEE CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68420
Mailing Address - Country:US
Mailing Address - Phone:402-852-3103
Mailing Address - Fax:
Practice Address - Street 1:600 I ST
Practice Address - Street 2:
Practice Address - City:PAWNEE CITY
Practice Address - State:NE
Practice Address - Zip Code:68420-3001
Practice Address - Country:US
Practice Address - Phone:402-852-2311
Practice Address - Fax:402-852-2170
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE832363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP04744Medicare UPIN
NE272557SMMedicare ID - Type Unspecified