Basic Information
| Provider Information | |||||||||
| NPI: | 1770585226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18400 KATY FWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770941295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816904678 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 18400 KATY FWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770941295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816904678 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | K7898 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | P01086519 | 01 | TX | RR MEDICARE | OTHER | 157059005 | 05 | TX | MEDICAID | 157059007 | 05 | TX | MEDICAID | P00668645 | 01 | TX | MEDICARE RAILROAD | OTHER | 157059004 | 05 | TX | MEDICAID | 610119705 | 01 | TX | US DEPT OF LABOR | OTHER | 157059002 | 05 | TX | MEDICAID | 157059003 | 05 | TX | MEDICAID | 157059006 | 05 | TX | MEDICAID | 8BN482 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 8DZ188 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |