1487985438 NPI number — AMANDA MAE RIZK CRNA

Table of content: AMANDA MAE RIZK CRNA (NPI 1487985438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487985438 NPI number — AMANDA MAE RIZK CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIZK
Provider First Name:
AMANDA
Provider Middle Name:
MAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRACHT
Provider Other First Name:
AMANDA
Provider Other Middle Name:
MAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487985438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX Z
Provider Second Line Business Mailing Address:
BATH COMMUNITY HOSPITAL
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24445-0750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-839-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 PARK DR
Provider Second Line Business Practice Location Address:
BATH COMMUNITY HOSPITAL
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24445-2921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-839-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  ARNP9301633 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , with the licence number: 87330 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 0024170863 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G006N . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 002121300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".