1609107408 NPI number — AMY D CRANK CRNA

Table of content: AMY D CRANK CRNA (NPI 1609107408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609107408 NPI number — AMY D CRANK CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRANK
Provider First Name:
AMY
Provider Middle Name:
D
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:
DALEY
Provider Other First Name:
AMY
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609107408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 HOLLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75020-4048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-903-9787
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13601 PRESTON RD
Provider Second Line Business Practice Location Address:
STE 1000W
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75240-4911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-663-8523
Provider Business Practice Location Address Fax Number:
972-663-8329
Provider Enumeration Date:
01/19/2010

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:  679937 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , with the licence number: 95279 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 210740102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200350010A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8807UB . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00983545 . This is a "RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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