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General NPI Number Information
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NPI Number | 1023249919
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Entity Type | Organization
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Legal Business Name | HERITAGE NETWORK PHYSICIAN
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Dates
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Enumeration Date | 07/27/2009
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 800 MOUNTAIN TER
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City | HURST
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State | TX
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Zip | 76053-4210
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Country | US
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Telephone | 682-626-5488
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Fax | 817-665-2974
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Provider Business Mailing Address
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Address Line | 800 MOUNTAIN TER
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City | HURST
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State | TX
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Zip | 76053-4210
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Country | US
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Telephone | 682-626-5488
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Fax | 817-665-2974
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD W SMITH
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Credential | D.O.
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Telephone | 682-626-5488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | E1757
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License Number State | TX
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