Healthcare Provider Details

I. General information

NPI: 1366642043
Provider Name (Legal Business Name): PAUL W. SMITH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6917 TRADONNA LN
NORTH RICHLAND HILLS TX
76180-4058
US

IV. Provider business mailing address

PO BOX 822516
NORTH RICHLAND HILLS TX
76182-2516
US

V. Phone/Fax

Practice location:
  • Phone: 817-553-5303
  • Fax: 817-553-5304
Mailing address:
  • Phone: 817-553-5303
  • Fax: 817-553-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL W. SMITH
Title or Position: SURGICAL FIRST ASSISTANT
Credential: RNFA
Phone: 817-553-5303