Basic Information
Provider Information
NPI: 1891347399
EntityType: 2
ReplacementNPI:  
OrganizationName: BAPTIST SAINT ANTHONY HEALTH SYSTEM
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Mailing Information
Address1: 6600 PLUM CREEK DR APT 259
Address2:  
City: AMARILLO
State: TX
PostalCode: 791241632
CountryCode: US
TelephoneNumber: 7086549177
FaxNumber:  
Practice Location
Address1: 1400 S COULTER ST
Address2:  
City: AMARILLO
State: TX
PostalCode: 791061786
CountryCode: US
TelephoneNumber: 8064149493
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/15/2019
LastUpdateDate: 07/15/2019
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: ELAGI
AuthorizedOfficialFirstName: DANIYAH
AuthorizedOfficialMiddleName: ALI
AuthorizedOfficialTitleorPosition: RESIDENT
AuthorizedOfficialTelephone: 7086549177
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y193400000X SINGLE SPECIALTY GROUPStudent, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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