1558369801 NPI number — DR. AMY K CRAWFORD-FIALLOS D.C.

Table of content: DR. AMY K CRAWFORD-FIALLOS D.C. (NPI 1558369801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558369801 NPI number — DR. AMY K CRAWFORD-FIALLOS D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAWFORD-FIALLOS
Provider First Name:
AMY
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
AMY
Provider Other Middle Name:
KRISTEN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558369801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/16/2006
NPI Reactivation Date:
03/21/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2414 TANGLEY ST BLDG B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77005-2514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-503-9687
Provider Business Mailing Address Fax Number:
713-668-8039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2414 TANGLEY ST BLDG B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77005-2514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-503-9687
Provider Business Practice Location Address Fax Number:
713-668-8039
Provider Enumeration Date:
07/11/2005

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: 111N00000X , with the licence number:  8801 , 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: 2232191 . This is a "FIRST HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1051703 . This is a "AMERICAN SPECIALTY HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5538184 . This is a "C C N" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8P5620 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 167691801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 667633 . This is a "A C N GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 760671946 . This is a "INTERPLAN HEATLH GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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