Provider Demographics
NPI:1326018847
Name:TAKEY CRIST MD PA
Entity Type:Organization
Organization Name:TAKEY CRIST MD PA
Other - Org Name:CRIST CLINIC FOR WOMEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-353-2115
Mailing Address - Street 1:250 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6332
Mailing Address - Country:US
Mailing Address - Phone:910-353-2115
Mailing Address - Fax:910-355-2422
Practice Address - Street 1:250 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6332
Practice Address - Country:US
Practice Address - Phone:910-353-2115
Practice Address - Fax:910-355-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40776207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01370OtherBLUE CROSS BLUE SHIELD
NC8901370Medicaid
NC8901370Medicaid