MEDICARE: AVA SMITH PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA11972	TX

General Provider Information

NPI Number	:	1023500709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVA SMITH PA

Provider Business Mailing Address
First Line	:	2900 E 29TH ST STE 100
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77802-2623
Country	:	US
Telephone Number	:	979-776-8440
Fax Number	:	877-601-5854

Provider Business Practice Location Address
First Line	:	8441 STATE HIGHWAY 47 STE 1400
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77807-3208
Country	:	US
Telephone Number	:	979-774-8200
Fax Number	:	877-601-5854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2018
Last Update Date	:	08/19/2020

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Directions to “ AVA SMITH PA” Practice Location

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