Provider Demographics
NPI:1609933613
Name:SMITH, CHAD ALLEN (CRNA)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:ALLEN
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2117
Mailing Address - Country:US
Mailing Address - Phone:713-378-3050
Mailing Address - Fax:713-378-3077
Practice Address - Street 1:4301 VISTA RD.
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2117
Practice Address - Country:US
Practice Address - Phone:713-378-3050
Practice Address - Fax:713-378-3077
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX628933367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88611UOtherBLUE CROSS
TX184884802Medicaid
8K4285Medicare PIN
TX184884802Medicaid