Provider Demographics
NPI:1174238182
Name:SMITH, COLT SAMUEL
Entity type:Individual
Prefix:MR
First Name:COLT
Middle Name:SAMUEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 NE REINKING RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64156-1122
Mailing Address - Country:US
Mailing Address - Phone:816-529-5436
Mailing Address - Fax:
Practice Address - Street 1:10450 NE REINKING RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64156-1122
Practice Address - Country:US
Practice Address - Phone:816-529-5436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider