Provider Demographics
NPI:1700019239
Name:SMITH & SMITH, PLLC
Entity Type:Organization
Organization Name:SMITH & SMITH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-C
Authorized Official - Phone:409-923-1650
Mailing Address - Street 1:2955 HARRISON STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1154
Mailing Address - Country:US
Mailing Address - Phone:409-923-1650
Mailing Address - Fax:409-923-1651
Practice Address - Street 1:2955 HARRISON STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1154
Practice Address - Country:US
Practice Address - Phone:409-923-1650
Practice Address - Fax:409-923-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211932301Medicaid
TX211932301Medicaid