1750355442 NPI number — SCOTT H SMITH MD

Table of content: SCOTT H SMITH MD (NPI 1750355442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750355442 NPI number — SCOTT H SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
SCOTT
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750355442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5002 LAKELAND CIR
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76710-2976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-752-2571
Provider Business Mailing Address Fax Number:
254-752-0699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5002 LAKELAND CIR
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76710-2976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-752-2571
Provider Business Practice Location Address Fax Number:
254-752-0699
Provider Enumeration Date:
02/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: H9572 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 034690702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com