=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659441715
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMC HOME HEALTH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 12/18/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 E KEECHI
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75840-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-389-9921
-----------------------------------------------------
Fax | 903-389-4479
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 E KEECHI
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75840-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-389-9921
-----------------------------------------------------
Fax | 903-389-4479
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. SUSAN E MARBERRY
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 903-389-3500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | 011622
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 011622
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------