Healthcare Provider Details

I. General information

NPI: 1275541112
Provider Name (Legal Business Name): SMITHVILLE HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 HIGHWAY 71 W SUITE C
BASTROP TX
78602-3931
US

IV. Provider business mailing address

441 HIGHWAY 71 W SUITE C
BASTROP TX
78602-3931
US

V. Phone/Fax

Practice location:
  • Phone: 512-304-0313
  • Fax: 512-237-5768
Mailing address:
  • Phone: 512-304-0313
  • Fax: 512-237-5768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ISABEL SHAW
Title or Position: BUSINESS MANAGER
Credential:
Phone: 512-237-3214