1952537011 NPI number — GREGORY W. SMITH MD PA

Table of content: (NPI 1952537011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952537011 NPI number — GREGORY W. SMITH MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREGORY W. SMITH MD PA
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:
1952537011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1768
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:
78296-1768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-542-1850
Provider Business Mailing Address Fax Number:
956-542-2879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1090 EAST ALTON GLOOR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78526-3822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-542-1850
Provider Business Practice Location Address Fax Number:
956-542-2879
Provider Enumeration Date:
06/03/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LIDBOM
Authorized Official First Name:
KIM
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
BILLING COORDINATOR
Authorized Official Telephone Number:
956-465-1091

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  K5700 , 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: 207043501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0040SM . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DP8222 . This is a "MEDICARE - RAIL ROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".