1386996874 NPI number — SMITH MEDICAL CLINIC, A TEXAS PROFESSIONAL ASSOCIATION

Table of content: (NPI 1386996874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386996874 NPI number — SMITH MEDICAL CLINIC, A TEXAS PROFESSIONAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMITH MEDICAL CLINIC, A TEXAS PROFESSIONAL ASSOCIATION
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:
1386996874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15055 EAST FWY
Provider Second Line Business Mailing Address:
SUITE B-30
Provider Business Mailing Address City Name:
CHANNELVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77530-4144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-452-3600
Provider Business Mailing Address Fax Number:
281-452-3122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15055 EAST FWY
Provider Second Line Business Practice Location Address:
SUITE B-30
Provider Business Practice Location Address City Name:
CHANNELVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77530-4144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-452-3600
Provider Business Practice Location Address Fax Number:
281-452-3122
Provider Enumeration Date:
10/08/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
281-452-3600

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  D7686 , 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: D7686 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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