Provider Demographics
NPI:1528140308
Name:SMA GROUP INCORPORATED
Entity type:Organization
Organization Name:SMA GROUP INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-521-8800
Mailing Address - Street 1:PO BOX 1893
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-0017
Mailing Address - Country:US
Mailing Address - Phone:214-635-3435
Mailing Address - Fax:214-635-3440
Practice Address - Street 1:8067 W VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3767
Practice Address - Country:US
Practice Address - Phone:214-635-3435
Practice Address - Fax:214-635-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX252863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2099659OtherPK
TX148921Medicaid
TX145723Medicaid