Mr Ethan Edward Smith, PA-C is a medicare enrolled "Physician Assistant" in Spooner, Wisconsin. He graduated from nursing school in 2024 and has 1 years of diverse experience with area of expertise as Physician Assistant. He is a member of the group practice St Marys Hospital Of Superior and his current practice location is
1180 Chandler Dr, Spooner, Wisconsin. You can reach out to his office (for appointments etc.) via phone at
(715) 635-2151.
Mr Ethan Edward Smith is licensed to practice in Wisconsin (license number 8040) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1073215984.
Provider's Profile
| Full Name | Mr Ethan Edward Smith |
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| Gender | Male |
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| Speciality | Physician Assistant |
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| Experience | 1 Years |
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| Location | 1180 Chandler Dr, Spooner, Wisconsin |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Mr Ethan Edward Smith graduated from nursing school in 2024
NPI Data:
- NPI Number: 1073215984
- Provider Enumeration Date: 03/22/2023
- Last Update Date: 09/11/2024
Medicare PECOS Information:
- PECOS PAC ID: 3375084783
- Enrollment ID: I20240925000347
Medical Identifiers
Medical identifiers for Mr Ethan Edward Smith such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1073215984 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363A00000X | Physician Assistant | 8040 (Wisconsin) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| St Marys Hospital Of Superior | 8628964228 | 75 |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Ethan Edward Smith is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Ethan Edward Smith, PA-C
400 E 3rd St,
Duluth, MN 55805-1951
Ph: (218) 786-8364 | Mr Ethan Edward Smith, PA-C
1180 Chandler Dr,
Spooner, WI 54801-2204
Ph: (715) 635-2151 |
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