Provider Demographics
NPI:1366412389
Name:SMITHVILLE REGIONAL HOSPITAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:SMITHVILLE REGIONAL HOSPITAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:PASSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-237-5716
Mailing Address - Street 1:PO BOX 268977
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8977
Mailing Address - Country:US
Mailing Address - Phone:512-237-5716
Mailing Address - Fax:512-237-5746
Practice Address - Street 1:800 HIGHWAY 71 E
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TX
Practice Address - Zip Code:78957-1730
Practice Address - Country:US
Practice Address - Phone:512-237-5716
Practice Address - Fax:512-237-5746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6646208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00231YMedicare ID - Type UnspecifiedGROUP