Active NPI
Eddie Buller Smith, MEDCCCSLP
- Speech-Language Pathologist
- Lufkin, TX
National Provider Identifier
1669620894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 18200
- Practice address
- 216 N John Redditt Dr
Lufkin, TX 75904-2620 - Phone
- (936) 632-2107
- NPI assigned
- Aug 29, 2008
- Last updated
- Aug 29, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 18200 | TX | Primary |
Addresses
Primary practice location
216 N John Redditt Dr
Lufkin, TX 75904-2620
Mailing address
216 N John Redditt Dr
Lufkin, TX 75904-2620
Phone (936) 632-2107
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18200 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219968000000",
"number": "1669620894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "216 N JOHN REDDITT DR",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759042620",
"telephone_number": "936-632-2107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "216 N JOHN REDDITT DR",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759042620",
"telephone_number": "936-632-2107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "EDDIE",
"middle_name": "BULLER",
"credential": "MEDCCCSLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-29",
"last_updated": "2008-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "18200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lufkin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.