JACK SMITH
NPI 1336934561
Student in an Organized Health Care Education/Training Program in Tupelo, MS
About Jack Smith NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACK SMITH (NPI 1336934561) is an individual student in an organized health care education/training program in Tupelo, Mississippi and active in the NPI registry since April 2025. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jack Smith is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
TUPELO, MS 38801
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jack Smith's NPI number?
The NPI number for Jack Smith is 1336934561. It was assigned to this individual provider in the NPPES registry on April 9, 2025.
Where is Jack Smith located?
Jack Smith practices at 830 S Gloster St, Tupelo, MS 38801. The listed phone number is (662) 377-3000.
What is Jack Smith's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Jack Smith enrolled in Medicare?
Yes. Jack Smith is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Jack Smith was last updated on April 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jack Smith · NPI 1336934561
Student in an Organized Health Care Education/Training Program provider in Tupelo, Mississippi. Individual provider, active in the CMS NPPES registry since April 9, 2025.
## Identity
- **NPI:** 1336934561 (Entity type: Individual)
- **Enumerated:** April 9, 2025
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **Sole proprietor:** No
## Practice location
- **Address:** 830 S GLOSTER ST, Tupelo, MS 38801-4934
- **Phone:** (662) 377-3000
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** April 9, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1336934561) · Data from the CMS NPPES public registry.