Provider Demographics
NPI:1922128172
Name:KRISTIN BUSSEY-SMITH MD PA
Entity Type:Organization
Organization Name:KRISTIN BUSSEY-SMITH MD PA
Other - Org Name:ALLERGY, ASTHMA, IMMUNOLOGY & RHEUMATOLOGY INSTITUTE (AAIR)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BUSSEY-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-495-4335
Mailing Address - Street 1:19260 STONE OAK PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3365
Mailing Address - Country:US
Mailing Address - Phone:210-495-4335
Mailing Address - Fax:210-587-7415
Practice Address - Street 1:19260 STONE OAK PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3365
Practice Address - Country:US
Practice Address - Phone:210-495-4335
Practice Address - Fax:210-587-7415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5080207K00000X, 207KA0200X, 207R00000X, 207RA0201X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191305501Medicaid
TX00Y245Medicare PIN