1881604437 NPI number — REBECCAH MAUD-CRAWFORD FIRST ASSIST

Table of content: REBECCAH MAUD-CRAWFORD FIRST ASSIST (NPI 1881604437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881604437 NPI number — REBECCAH MAUD-CRAWFORD FIRST ASSIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAUD-CRAWFORD
Provider First Name:
REBECCAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FIRST ASSIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRAWFORD
Provider Other First Name:
REBECCAH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FIRST ASSIST
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1881604437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 W 40TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78756-4010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-459-8753
Provider Business Mailing Address Fax Number:
512-483-6807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 W 40TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78756-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-459-8753
Provider Business Practice Location Address Fax Number:
512-483-6807
Provider Enumeration Date:
08/08/2006

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: 246ZS0410X , with the licence number:  SA00063 , 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: 8N4583 . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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