1669869608 NPI number — DRIVEN BY DIVINE INTERVENTION COMMUNITY DEVELOPMENT CORPORATION

Table of content: DR. MARTY E. SMITH D.PH. (NPI 1588770085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669869608 NPI number — DRIVEN BY DIVINE INTERVENTION COMMUNITY DEVELOPMENT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRIVEN BY DIVINE INTERVENTION COMMUNITY DEVELOPMENT CORPORATION
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:
6
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:
1669869608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5330 GRIGGS RD STE B110
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:
77021-3779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-658-7033
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1051 MEADS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANNELVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77530-2953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-658-7033
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MCCORVEY
Authorized Official First Name:
SHERITA
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-658-7033

Provider Taxonomy Codes

  • Taxonomy code: 3104A0625X , 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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