Provider Demographics
NPI:1952537011
Name:GREGORY W. SMITH MD PA
Entity type:Organization
Organization Name:GREGORY W. SMITH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIDBOM-OXFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-465-1091
Mailing Address - Street 1:PO BOX 1768
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78296-1768
Mailing Address - Country:US
Mailing Address - Phone:956-542-1850
Mailing Address - Fax:956-542-2879
Practice Address - Street 1:602 KAIMALI DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-0233
Practice Address - Country:US
Practice Address - Phone:956-412-1100
Practice Address - Fax:956-412-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TXK5700207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207043501Medicaid
TXDP8222OtherMEDICARE - RAIL ROAD
TX0040SMOtherBLUE CROSS BLUE SHIELD
TX0040SMOtherBLUE CROSS BLUE SHIELD
TX0040SMOtherBLUE CROSS BLUE SHIELD