1679760177 NPI number — EILEEN A. SMITH M.D., P.A.

Table of content: (NPI 1679760177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679760177 NPI number — EILEEN A. SMITH M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EILEEN A. SMITH M.D., P.A.
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:
1679760177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34567
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78265-4567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-967-0515
Provider Business Mailing Address Fax Number:
210-655-9697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8601 VILLAGE DR
Provider Second Line Business Practice Location Address:
118
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78217-5512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-967-0515
Provider Business Practice Location Address Fax Number:
210-655-9697
Provider Enumeration Date:
09/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ESTRADA
Authorized Official First Name:
EVONNIE
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
210-967-0515

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  TXJ1141 , 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: DN8900 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0002MG . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 171599701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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