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NPI Code Detail

MEDICARE: SMMC MEDICAL GROUP

MEDICARE: SMMC MEDICAL GROUP
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
1261QR1300XRural Health Clinic/Center

General Provider Information

NPI Number : 1194239905
Entity Type Code : Organization
Provider Name (Legal Business Name) : SMMC MEDICAL GROUP
Provider Business Mailing Address
First Line : PO BOX 5009
Second Line :
City : BRENTWOOD
State : TN
Zip : 37024-5009
Country : US
Telephone Number : 615-221-1400
Fax Number :
Provider Business Practice Location Address
First Line : 2301 S GREGG ST
Second Line :
City : BIG SPRING
State : TX
Zip : 79720-5531
Country : US
Telephone Number : 432-267-5531
Fax Number : 432-268-1010
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : SOPHIA ARWOOD
Credential :
Telephone Number : 615-221-3851
Provider Enumeration Date : 12/01/2017
Last Update Date : 10/16/2018

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Directions to “SMMC MEDICAL GROUP ” Practice Location

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