Provider Demographics
NPI:1609807858
Name:HERITAGE NETWORK PHYSICIAN
Entity Type:Organization
Organization Name:HERITAGE NETWORK PHYSICIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-282-6905
Mailing Address - Street 1:729 W BEDFORD EULESS RD
Mailing Address - Street 2:STE 108
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-3939
Mailing Address - Country:US
Mailing Address - Phone:817-282-6905
Mailing Address - Fax:817-282-0939
Practice Address - Street 1:729 W BEDFORD EULESS RD
Practice Address - Street 2:STE 108
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-3939
Practice Address - Country:US
Practice Address - Phone:817-282-6905
Practice Address - Fax:817-282-0939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty