1568581668 NPI number — AMARILLO CRITICAL CARE SERVICES,P.A.

Table of content: (NPI 1568581668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568581668 NPI number — AMARILLO CRITICAL CARE SERVICES,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMARILLO CRITICAL CARE SERVICES,P.A.
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:
WILLIAM GILL, M.D.
Provider Other Organization Name Type Code:
3
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:
1568581668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26423 BURTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRISFIELD
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21817-1248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-968-0937
Provider Business Mailing Address Fax Number:
410-968-2240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26423 BURTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRISFIELD
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21817-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-968-0937
Provider Business Practice Location Address Fax Number:
410-968-2240
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GILL
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-968-0937

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  D0015715 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 352239-01 . This is a "BCBS OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R872-0001 . This is a "BCBS BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 816580 . This is a "MDIPA & OPTIMUM CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0101147 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 99833 . This is a "COVENTRY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P14270 . This is a "BCBS POINT OF SERVICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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