Provider Demographics
NPI:1225275704
Name:PLENARY MUA INSTITUTE, LLC
Entity Type:Organization
Organization Name:PLENARY MUA INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-960-8575
Mailing Address - Street 1:2301 YORKTOWN ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-4570
Mailing Address - Country:US
Mailing Address - Phone:713-960-8575
Mailing Address - Fax:713-960-8594
Practice Address - Street 1:2301 YORKTOWN ST
Practice Address - Street 2:SUITE 209
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-4570
Practice Address - Country:US
Practice Address - Phone:713-960-8575
Practice Address - Fax:713-960-8594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62132081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGOtherBCBS