Provider Demographics
NPI:1457432924
Name:PHILIPP, AMY C (DO)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:PHILIPP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:9840 N BEACH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6184
Practice Address - Country:US
Practice Address - Phone:817-431-3898
Practice Address - Fax:817-379-1161
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2551208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760027OtherAETNA PIN
TX8951478OtherCIGNA PIN
TXPHIA456738OtherCCHIP PIN
TX84312SOtherBCBSTX IND PIN
TX2115312OtherUHC PIN
1750369203OtherGRP NPI NUMBER
TX1958119OtherFIRSTHEALTH PIN
TX146616104Medicaid
TX00U87ZOtherBCBSTX GRP PIN
TX140543100OtherFIRSTCARE PIN
TX00408KMedicare PIN
TXPHIA456738OtherCCHIP PIN
H47857Medicare UPIN
TXPHIA456738OtherCCHIP PIN
H47857Medicare UPIN