Provider Demographics
NPI:1760652978
Name:SMG SIGNATURE MEDICAL GROUP
Entity Type:Organization
Organization Name:SMG SIGNATURE MEDICAL GROUP
Other - Org Name:GULF COAST MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:STERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-758-1258
Mailing Address - Street 1:2022 REGIONAL MEDICAL DRIVE
Mailing Address - Street 2:SUITE 1319
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488
Mailing Address - Country:US
Mailing Address - Phone:979-531-8801
Mailing Address - Fax:979-531-8802
Practice Address - Street 1:2022 REGIONAL MEDICAL DRIVE
Practice Address - Street 2:SUITE 1319
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488
Practice Address - Country:US
Practice Address - Phone:979-531-8801
Practice Address - Fax:979-531-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty