Provider Demographics
NPI:1043404494
Name:WEST MEDICAL AND SURGICAL CLINIC ASSOCIATION
Entity Type:Organization
Organization Name:WEST MEDICAL AND SURGICAL CLINIC ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:NORVELL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:254-826-5372
Mailing Address - Street 1:500 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WEST
Mailing Address - State:TX
Mailing Address - Zip Code:76691-1017
Mailing Address - Country:US
Mailing Address - Phone:254-826-5372
Mailing Address - Fax:254-826-5371
Practice Address - Street 1:500 MEADOW DR
Practice Address - Street 2:
Practice Address - City:WEST
Practice Address - State:TX
Practice Address - Zip Code:76691-1017
Practice Address - Country:US
Practice Address - Phone:254-826-5372
Practice Address - Fax:254-826-5371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5251261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA67677Medicare UPIN