1255751996 NPI number — MAURA SMITH APRN, AGACNP-BC

Table of content: MAURA SMITH APRN, AGACNP-BC (NPI 1255751996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255751996 NPI number — MAURA SMITH APRN, AGACNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
MAURA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, AGACNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RINEHIMER
Provider Other First Name:
MAURA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255751996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4439
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77210-4439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-792-2991
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 HOLCOMBE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-4009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-792-6161
Provider Business Practice Location Address Fax Number:
409-772-5052
Provider Enumeration Date:
04/21/2014

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: 363LC0200X , with the licence number:  786628 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: AP125136 , 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: 348655705 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 348655701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8417NW . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 348655706 . This is a "MEDICAID CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8664NM . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 348655702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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