FULL SMILE DENTAL, PLLC — NPI 1558964536 (Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center in FARWELL, TX)

CMS-1500 Box 24J / 33a • NPI

1558964536

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

261QS0112X

Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center

Box 32 Service Location & ZIP+4

816 AVENUE A, FARWELL, TX, 79325

Official NPPES Practice Location

Practice Phone & Referral Fax

(806) 353-1055

Fax: (806) 353-7077

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1558964536 (FULL SMILE DENTAL, PLLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1558964536` (NPI-2 Organization / Facility)
Provider / Legal Name	FULL SMILE DENTAL, PLLC
Plain-English Specialty	Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: `261QS0112X` (Clinic/Center, Oral and Maxillofacial Surgery)
Certifying / Licensing Body	Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Practice Location Address	816 AVENUE A, FARWELL, TX, 79325
Practice Telephone / Fax	Tel: (806) 353-1055 \| Fax: (806) 353-7077
Administrative Mailing Address	5051 S SONCY RD, AMARILLO, TX, 79119-6667
Enumeration & Last Sync	Enumerated: 2020-11-20 \| CMS Record Updated: 2020-11-20
Authorized Official	JENNIFER WILLIAMS (Credentialing)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

816 AVENUE A, FARWELL, TX, 79325

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Plain-English Taxonomy & CMS Crosswalk (261QS0112X)

What Does Taxonomy Code 261QS0112X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QS0112X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Clinical Scope: Same-day outpatient consultations, urgent walk-in medical care, vaccinations, and day-case diagnostic procedures.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (FULL SMILE DENTAL, PLLC)

Typical CPT / Diagnostic Procedures:

Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures

Common Therapeutic Classes:

Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`1223G0001X` — Dentist, General Practice Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: N/A \| License: `Verified` \| Primary: Secondary
`261QS0112X` — Clinic/Center, Oral and Maxillofacial Surgery Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

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FULL SMILE DENTAL, PLLC (NPI #1558964536)