Healthcare Provider Details

I. General information

NPI: 1154286755
Provider Name (Legal Business Name): ETX METABOLIC SYNDROME RELIEF PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 NORTH ST STE 100
NACOGDOCHES TX
75961-4010
US

IV. Provider business mailing address

1220 NORTH ST STE 100
NACOGDOCHES TX
75961-4010
US

V. Phone/Fax

Practice location:
  • Phone: 214-680-6993
  • Fax:
Mailing address:
  • Phone: 214-680-6993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMMY D SMITH
Title or Position: CO-OWNER
Credential: CNS
Phone: 936-707-0921