Provider Demographics
NPI:1992525281
Name:SMITH, LARONE
Entity type:Individual
Prefix:
First Name:LARONE
Middle Name:
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 1:12830 E TIMBER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-6501
Mailing Address - Country:US
Mailing Address - Phone:316-209-0940
Mailing Address - Fax:
Practice Address - Street 1:12830 E TIMBER LAKE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67230-6501
Practice Address - Country:US
Practice Address - Phone:316-209-0940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS343800000X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No343800000XTransportation ServicesSecured Medical Transport (VAN)