Provider Demographics
NPI:1831581123
Name:SMAC PODIATRY
Entity type:Organization
Organization Name:SMAC PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:NEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:281-731-5610
Mailing Address - Street 1:16339 LAURELFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-6519
Mailing Address - Country:US
Mailing Address - Phone:281-731-5610
Mailing Address - Fax:
Practice Address - Street 1:17045 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2649
Practice Address - Country:US
Practice Address - Phone:281-731-5610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1388261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric