Provider Demographics
NPI:1417379447
Name:WEST STATE MHT LLC
Entity Type:Organization
Organization Name:WEST STATE MHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF REGULATORY COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-860-2109
Mailing Address - Street 1:1515 HERITAGE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3379
Mailing Address - Country:US
Mailing Address - Phone:855-860-2109
Mailing Address - Fax:855-814-8428
Practice Address - Street 1:379 PEAVY RD
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-9514
Practice Address - Country:US
Practice Address - Phone:855-860-2109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11865R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty