Provider Demographics
NPI:1164056750
Name:SMB HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:SMB HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:601-454-1847
Mailing Address - Street 1:3604 S W S YOUNG DR APT 328
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-2943
Mailing Address - Country:US
Mailing Address - Phone:601-454-1847
Mailing Address - Fax:
Practice Address - Street 1:3604 S W S YOUNG DR APT 328
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2943
Practice Address - Country:US
Practice Address - Phone:601-454-1847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty