Provider Demographics
NPI:1316074065
Name:SMITH COSMETIC SURGERY CENTER
Entity type:Organization
Organization Name:SMITH COSMETIC SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RAYNARD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-795-0600
Mailing Address - Street 1:6410 FANNIN ST
Mailing Address - Street 2:SUITE 810
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3000
Mailing Address - Country:US
Mailing Address - Phone:713-795-0600
Mailing Address - Fax:713-795-0862
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:SUITE 810
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:713-795-0600
Practice Address - Fax:713-795-0862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2793207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3261901OtherBLUE LINK
TXU79HOtherBLUE CROSS BLUE SHIELD
TX1033185178OtherTYPE 1 NPI
TX1033274253OtherOUR NPI FOR PALLADIUM
TXU79HOtherBLUE CROSS BLUE SHIELD
TX1033185178OtherTYPE 1 NPI