=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588568737
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORRECTIONAL MEDICAL ASSOCIATES OF TEXAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2026
-----------------------------------------------------
Last Update Date | 10/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 EL RANCHO WAY
-----------------------------------------------------
City | DILLEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78017-4200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-965-5671
-----------------------------------------------------
Fax | 830-378-6599
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 EL RANCHO WAY
-----------------------------------------------------
City | DILLEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78017-4200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 629-335-0119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | DR. WALKITRIA SMITH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 629-335-0119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2400X
-----------------------------------------------------
Taxonomy Name | Prison Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------