Provider Demographics
NPI:1861449092
Name:SMITHVILLE HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:SMITHVILLE HOSPITAL AUTHORITY
Other - Org Name:RIVERBEND MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GRADY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:512-237-3214
Mailing Address - Street 1:441 HIGHWAY 71 W
Mailing Address - Street 2:SUITE C
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3931
Mailing Address - Country:US
Mailing Address - Phone:512-304-0313
Mailing Address - Fax:512-304-0326
Practice Address - Street 1:441 HIGHWAY 71 W
Practice Address - Street 2:SUITE C
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3931
Practice Address - Country:US
Practice Address - Phone:512-304-0313
Practice Address - Fax:512-304-0326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4693207Q00000X
TXL4729208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W129Medicaid
TX8F2274Medicare ID - Type UnspecifiedPHYSICIAN # UNDER GROUP
TX00W129Medicaid