1881695864 NPI number — DR. CHRISTINE D CRISCUOLO HIGGINS MD

Table of content: DR. CHRISTINE D CRISCUOLO HIGGINS MD (NPI 1881695864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881695864 NPI number — DR. CHRISTINE D CRISCUOLO HIGGINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRISCUOLO HIGGINS
Provider First Name:
CHRISTINE
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
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:
1881695864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11130 CHRISTUS HILLS
Provider Second Line Business Mailing Address:
2ND FLOOR, SUITE 201
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78251-3584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-703-9001
Provider Business Mailing Address Fax Number:
210-703-9155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11130 CHRISTUS HILLS
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-703-9001
Provider Business Practice Location Address Fax Number:
210-703-9155
Provider Enumeration Date:
08/02/2005

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: 207Q00000X , with the licence number:  M1063 , 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: 1048212 . This is a "BLUELINK ACCESS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1745440-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7393713 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1745440-02 . This is a "CSHCN MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 9391864 . This is a "PRIVATE HEALTHCARE SYST" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 6030526 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5632580 . This is a "FIRST HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 742806531V . This is a "HUMANA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8J8363 . This is a "BLUECROSSBLUESHIELD TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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