MEDICARE: MR. MARCUS ANDREW SMITH M.D.

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	207T00000X	Neurological Surgery Physician	N1153	TX
2	174400000X	Specialist	N1153	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00738165	OTHER	TX	RAILROAD MEDICARE
6	8L14510	OTHER	TX	INDIVIDUAL PTAN MEDICARE
13	1G2371	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	179117500	OTHER	TX	US DEPARTMENT OF LABOR
2	85751	OTHER	AR	BLUE CROSS BLUE SHIELD OF ARKANSAS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	1093929150	OTHER	TX	QUALCHOICE
8	1871793307	OTHER		CIGNA DME#
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	P02599421	OTHER	TX	RR MCR
11	1093929150	OTHER	TX	TRICARE- HUMANA MILITARY
12	1093929150	OTHER		HUMANA MILITARY
14	MDN1153	OTHER	TX	TEXAS WORKERS' COMPENSATION

General Provider Information

NPI Number	:	1093929150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCUS ANDREW SMITH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9600
Second Line	:	DEPARTMENT 09-019
City	:	TEXARKANA
State	:	TX
Zip	:	75505-9600
Country	:	US
Telephone Number	:	903-794-4196
Fax Number	:	903-792-7408

Provider Business Practice Location Address
First Line	:	2602 SAINT MICHAEL DR STE 302B
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-5228
Country	:	US
Telephone Number	:	903-794-4196
Fax Number	:	903-614-5190

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	04/27/2026

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