Organization
ICW TA
Active
Other names
FAMILY HEALTH CLINIC OF TEXOMA
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT SHAWN SMITH MS, PA-C (OWNER)
(940) 851-9900
Entity
Organization
Contact information
Practice address
1411 13TH ST, WICHITA FALLS, TX 76301-7100
(940) 851-9900
(940) 851-8089
Mailing address
1411 13TH ST STE 2, WICHITA FALLS, TX 76301-7100
(940) 851-9900
(940) 851-8089
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00159
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0056MG
BCBS
TX
05
—
172462702
—
TX
05
—
17262701
—
TX
Enumeration date
11/01/2006
Last updated
11/06/2008
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