| Travis L Smith, CRNA | |
|
1373 E State Road 62, Madison, IN 47250-7328 | |
| (812) 801-0609 | |
| (812) 801-0276 |
| Full Name | Travis L Smith |
|---|---|
| Gender | Male |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 1373 E State Road 62, Madison, Indiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215914445 | NPI | - | NPPES |
| 200946180 | Medicaid | IN | |
| 74009473 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 3004523 (Kentucky) | Primary |
| Entity Name | Bluegrass Anesthesia Services, PSC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1548355100 PECOS PAC ID: 6305750209 Enrollment ID: O20031114000601 |
| Entity Name | Louisville Anesthesia Provision LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1548442650 PECOS PAC ID: 2567533839 Enrollment ID: O20080613000007 |
| Entity Name | Lec Ancillary PLLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1982917365 PECOS PAC ID: 0345364725 Enrollment ID: O20100908000467 |
| Entity Name | Resource Anesthesia Cumberland Valley Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780930743 PECOS PAC ID: 2961652755 Enrollment ID: O20121102000100 |
| Entity Name | Anesthesia Group Practice Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1417951948 PECOS PAC ID: 1254245137 Enrollment ID: O20151204001398 |
| Entity Name | Professional Anesthesia Services of Kentucky PLLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1992212807 PECOS PAC ID: 0244590305 Enrollment ID: O20180209000936 |
| Entity Name | North Clark Medical Group LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1376095711 PECOS PAC ID: 3971879354 Enrollment ID: O20180216002232 |
| Entity Name | Providian Anesthesia LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1821654666 PECOS PAC ID: 2264765791 Enrollment ID: O20190614000874 |
| Entity Name | Capital Anesthesia Solutions of Kentucky LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1023665882 PECOS PAC ID: 0446681548 Enrollment ID: O20200505001112 |
| Entity Name | Anesthesia Dynamics LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073001012 PECOS PAC ID: 3779832530 Enrollment ID: O20210104001507 |
| Mailing Address | Practice Location Address |
|---|---|
| Travis L Smith, CRNA Dept 86236, Po Box 950195, Louisville, KY 40295-0195 Ph: (502) 473-2100 | Travis L Smith, CRNA 1373 E State Road 62, Madison, IN 47250-7328 Ph: (812) 801-0609 |
Kenneth L Harding Jr., C.R.N.A. Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 1373 E State Road 62, Madison, IN 47250 Phone: 812-801-0156 Fax: 812-801-0276 |