Provider Demographics
NPI:1275722795
Name:PHILIP H CROYLE MD PA
Entity Type:Organization
Organization Name:PHILIP H CROYLE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:H
Authorized Official - Last Name:CROYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-751-1700
Mailing Address - Street 1:PO BOX 23690
Mailing Address - Street 2:SUITE D
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-3690
Mailing Address - Country:US
Mailing Address - Phone:254-751-1700
Mailing Address - Fax:254-751-0700
Practice Address - Street 1:300 RICHLAND WEST CIR
Practice Address - Street 2:SUITE 2
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7935
Practice Address - Country:US
Practice Address - Phone:254-751-1700
Practice Address - Fax:254-751-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1838174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159630601OtherTPI
TX159630601Medicaid
TX8AJ848OtherBCBS
TXB22052OtherUPIN
TXE1838OtherTX LIC.
TX0033QSOtherBCBS GROUP
TXB22052OtherUPIN