Basic Information
Provider Information | |||||||||
NPI: | 1790768844 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SMITHVILLE HOSPITAL AUTHORITY | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SMITHVILLE REGIONAL HOSPITAL | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 800 E HIGHWAY 71 | ||||||||
Address2: |   | ||||||||
City: | SMITHVILLE | ||||||||
State: | TX | ||||||||
PostalCode: | 789571730 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5122373214 | ||||||||
FaxNumber: | 5122375768 | ||||||||
Practice Location | |||||||||
Address1: | 800 E HIGHWAY 71 | ||||||||
Address2: |   | ||||||||
City: | SMITHVILLE | ||||||||
State: | TX | ||||||||
PostalCode: | 789571730 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5122373214 | ||||||||
FaxNumber: | 5122375768 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/22/2005 | ||||||||
LastUpdateDate: | 10/15/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SHAW | ||||||||
AuthorizedOfficialFirstName: | ISABEL | ||||||||
AuthorizedOfficialMiddleName: | E | ||||||||
AuthorizedOfficialTitleorPosition: | BILLING OFFICE MANAGER | ||||||||
AuthorizedOfficialTelephone: | 5122375770 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 000385 | TX | Y |   | Hospitals | General Acute Care Hospital |   |
No ID Information.