Jacob Smith, PA-C, ATC

NPI 1548675945 · on the registry since 2014 · sole proprietor

Practice

Address: 1111 Trinity Ln Ste 111
Bloomington, IL 61704
Phone: (309) 663-6461
Organisation at this address: Carle West Physician Group Inc
Twin Cities Medical Equipment Llc
Bloomington Medical Distribution Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 53

Registry record

Primary taxonomy: Physician Assistant
363A00000X
Also registered as: Medical Physician Assistant
Licence states on file: IL
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2022-03-30

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois