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General NPI Number Information
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NPI Number | 1124147723
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Entity Type | Organization
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Legal Business Name | WEST LOOP MEDICAL CLINIC INC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 2531 LOOP 306
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City | SAN ANGELO
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State | TX
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Zip | 76904-7629
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Country | US
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Telephone | 325-224-4980
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Fax |
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Provider Business Mailing Address
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Address Line | 2531 LOOP 306
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City | SAN ANGELO
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State | TX
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Zip | 76904-7629
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN H SMITH
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Credential | MD
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Telephone | 325-224-4980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J0271
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License Number State | TX
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