# SMITH COSMETIC SURGERY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316074065
- **Authorized official:** DR. KEVIN RAYNARD SMITH M.D. (MEDICAL DOCTOR)
- **Authorized official phone:** (713) 795-0600

## Contact information

- **Practice address:** 6410 FANNIN ST, SUITE 810, HOUSTON, TX 77030-3000
- **Practice address phone:** (713) 795-0600
- **Practice address fax:** (713) 795-0862
- **Mailing address:** 6410 FANNIN ST, SUITE 810, HOUSTON, TX 77030-3000
- **Mailing address phone:** (713) 795-0600
- **Mailing address fax:** (713) 795-0862

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | H2793 | TX | Yes |

## Other

- **Enumeration date:** 02/28/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1033185178 | TYPE 1 NPI | TX |
| 01 | — | 1033274253 | OUR NPI FOR PALLADIUM | TX |
| 01 | — | 3261901 | BLUE LINK | TX |
| 01 | — | U79H | BLUE CROSS BLUE SHIELD | TX |