Provider Demographics
NPI:1700804002
Name:HILL, SAM SMITH III (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:SMITH
Last Name:HILL
Suffix:III
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 OCEAN DR APT A
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1466
Mailing Address - Country:US
Mailing Address - Phone:361-851-2444
Mailing Address - Fax:
Practice Address - Street 1:DRISCOLL CHILDREN'S HOSPITAL
Practice Address - Street 2:3533 S. ALAMEDA ST.
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-694-5000
Practice Address - Fax:361-694-4257
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24923103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1135377803Medicaid