Provider Demographics
NPI:1306197785
Name:TERESA MARQUEZ-SMITH M.D.P.A.
Entity Type:Organization
Organization Name:TERESA MARQUEZ-SMITH M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-838-1400
Mailing Address - Street 1:11410 VISTA DEL SOL DR STE B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5332
Mailing Address - Country:US
Mailing Address - Phone:915-838-1400
Mailing Address - Fax:915-838-1406
Practice Address - Street 1:11410 VISTA DEL SOL DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5332
Practice Address - Country:US
Practice Address - Phone:915-838-1400
Practice Address - Fax:915-838-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6014332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126489703Medicaid
TX126489704Medicaid
TX00N125OtherMEDICARE ID TYPE UNSPECIFIED
TX126489701Medicaid
TX126489702Medicaid
TX126489702Medicaid