1801821145 NPI number — AMY MAXWELL MD

Table of content: AMY MAXWELL MD (NPI 1801821145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801821145 NPI number — AMY MAXWELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAXWELL
Provider First Name:
AMY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801821145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 277711
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-7711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 N OREGON ST
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPT
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-3524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-521-1200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2006

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: 2085B0100X , with the licence number:  M3317 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 127552 . This is a "SUPERIOR SSI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 23404752 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: MDM3317TX . This is a "WORKERS COMP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 192080301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 85616Y . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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