1316074065 NPI number — SMITH COSMETIC SURGERY CENTER

Table of content: (NPI 1316074065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316074065 NPI number — SMITH COSMETIC SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMITH COSMETIC SURGERY CENTER
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:
1316074065
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6410 FANNIN ST
Provider Second Line Business Mailing Address:
SUITE 810
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-795-0600
Provider Business Mailing Address Fax Number:
713-795-0862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6410 FANNIN ST
Provider Second Line Business Practice Location Address:
SUITE 810
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-795-0600
Provider Business Practice Location Address Fax Number:
713-795-0862
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
RAYNARD
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
713-795-0600

Provider Taxonomy Codes

  • Taxonomy code: 207YS0123X , with the licence number:  H2793 , 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: 3261901 . This is a "BLUE LINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: U79H . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1033185178 . This is a "TYPE 1 NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1033274253 . This is a "OUR NPI FOR PALLADIUM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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