Provider Demographics
NPI:1679760177
Name:EILEEN A. SMITH M.D., P.A.
Entity Type:Organization
Organization Name:EILEEN A. SMITH M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVONNIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-967-0515
Mailing Address - Street 1:PO BOX 34567
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-4567
Mailing Address - Country:US
Mailing Address - Phone:210-967-0515
Mailing Address - Fax:210-655-9697
Practice Address - Street 1:8601 VILLAGE DR
Practice Address - Street 2:118
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5512
Practice Address - Country:US
Practice Address - Phone:210-967-0515
Practice Address - Fax:210-655-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXJ11412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDN8900OtherMEDICARE RAILROAD
TX0002MGOtherBCBS
TX171599701Medicaid
TX171599701Medicaid
TXPOOO79579Medicare PIN
TX00235YMedicare PIN