Basic Information
| Provider Information | |||||||||
| NPI: | 1952325573 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRAWFORD ANDREWS & DAVIS PTR | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RADIOLOGY ASSOCIATES, L.L.P. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3560 DELAWARE ST STE 209 | ||||||||
| Address2: | |||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777063059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098993684 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3560 DELAWARE ST STE 209 | ||||||||
| Address2: | |||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777063059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098993684 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 12/18/2019 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | K. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4098933933 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/18/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 094839001 | 05 | TX | MEDICAID |