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Samantha Jo Smith

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

PECOS Enrollment

This provider is enrolled in PECOS as SAMANTHA SMITH.

Based on the most recent information from CMS, provider Samantha Jo Smith is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 9:43 AM.

Profile Details

Provider ID
1992270557
Provider Type
Individual
Full Name
Smith, Samantha Jo
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
10/10/2018
Last Updated
2/17/2020

Contact Information

Practice Location

1000 E Park Blvd, Boise, ID 83712-7791

(208) 871-0644

Unlisted Fax

Mailing Location

3622 W Sunset Ave, Boise, ID 83703-4855

(208) 871-0644

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer Idaho

Samantha Jo Smith

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Derkacs, Derek

Collins, Brittany

Fritz, Lyndsey

Mcreynolds, Mariah Emily

Meziere, Lauren

Cole-Riccardi, Michelle Denise

Chism, Sarah

Jessup, Alice Rachel

Bowman, Dustin K

Baggs, Jacqueline