1326667551 NPI number — DR. CAROL SMELTZ MD, PHD, MS, RD, LD

Table of content: DEREK AILES M.D. (NPI 1992001804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326667551 NPI number — DR. CAROL SMELTZ MD, PHD, MS, RD, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMELTZ
Provider First Name:
CAROL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD, MS, RD, LD
Provider Gender Code:
F

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:
1326667551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3422 BUSINESS CENTER DR STE 106-1312
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77584-4155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-661-7778
Provider Business Mailing Address Fax Number:
979-661-7779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4403 MARKSTONE RIDGE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSHARON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77583-1754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-661-7778
Provider Business Practice Location Address Fax Number:
979-661-7779
Provider Enumeration Date:
04/08/2020

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: 163WD0400X , with the licence number:  32100475 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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