1003307489 NPI number — BRAZORIA COUNTY EMERGENCY SERVICES DISTRICT 3

Table of content: JANE MCCROSSEN RN CNP (NPI 1528099553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003307489 NPI number — BRAZORIA COUNTY EMERGENCY SERVICES DISTRICT 3

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAZORIA COUNTY EMERGENCY SERVICES DISTRICT 3
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:
1003307489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1253
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANVEL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77578-1253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-519-8779
Provider Business Mailing Address Fax Number:
281-489-0024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6931 MASTERS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANVEL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77578-4782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-519-8779
Provider Business Practice Location Address Fax Number:
281-489-0024
Provider Enumeration Date:
05/22/2018

Additional Information

Authorized Official

Authorized Official Last Name:
WELCH
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
LANCE
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
281-519-8779

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1000984 , 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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