Provider Demographics
NPI:1386996874
Name:SMITH MEDICAL CLINIC, A TEXAS PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:SMITH MEDICAL CLINIC, A TEXAS PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-452-3600
Mailing Address - Street 1:15055 EAST FWY
Mailing Address - Street 2:SUITE B-30
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-4144
Mailing Address - Country:US
Mailing Address - Phone:281-452-3600
Mailing Address - Fax:281-452-3122
Practice Address - Street 1:15055 EAST FWY
Practice Address - Street 2:SUITE B-30
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-4144
Practice Address - Country:US
Practice Address - Phone:281-452-3600
Practice Address - Fax:281-452-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7686208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD7686OtherMEDICAL LICENSE