1174996623 NPI number — FUSI AND CRAIG PLASTIC SURGERY, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174996623 NPI number — FUSI AND CRAIG PLASTIC SURGERY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FUSI AND CRAIG PLASTIC SURGERY, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1174996623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1544 SAWDUST RD
Provider Second Line Business Mailing Address:
STE 280
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77380-2929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-292-7411
Provider Business Mailing Address Fax Number:
281-292-7481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6560 FANNIN ST
Provider Second Line Business Practice Location Address:
STE 704
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-292-7411
Provider Business Practice Location Address Fax Number:
281-292-7481
Provider Enumeration Date:
11/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CRAIG
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-292-7411

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  P5952 , 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)





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