1205041860 NPI number — MARCUS DARNELL SMITH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205041860 NPI number — MARCUS DARNELL SMITH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARCUS DARNELL SMITH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1205041860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6700 WOODLANDS PARKWAY
Provider Second Line Business Mailing Address:
SUITE 230-312
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77382-2575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-465-4555
Provider Business Mailing Address Fax Number:
281-298-2456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6700 WOODLANDS PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 230-312
Provider Business Practice Location Address City Name:
THE WOODLANDS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77382-2575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-465-4555
Provider Business Practice Location Address Fax Number:
281-298-2456
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
MARCUS
Authorized Official Middle Name:
DARNELL
Authorized Official Title or Position:
INTERNIST HOSPITALIST
Authorized Official Telephone Number:
281-465-4555

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  M0278 , 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)





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