Basic Information
| Provider Information | |||||||||
| NPI: | 1013270602 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCOTT AND WHITE HEALTH PLAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3010 IRA YOUNG DR | ||||||||
| Address2: | #516 | ||||||||
| City: | TEMPLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765046300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814147712 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2401 S 31ST ST | ||||||||
| Address2: | |||||||||
| City: | TEMPLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765080001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547242111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2012 | ||||||||
| LastUpdateDate: | 06/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | CROSHAW | ||||||||
| AuthorizedOfficialFirstName: | JEANIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | RESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2814147712 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | BP10042530 | TX | Y | Hospitals | Psychiatric Hospital |
No ID Information.