Provider Demographics
NPI:1144631052
Name:ALAMOSA FOOT AND NAIL CARE MEDICAL SERVICES
Entity type:Organization
Organization Name:ALAMOSA FOOT AND NAIL CARE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BIRDSONG
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:281-684-9575
Mailing Address - Street 1:PO BOX 732
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-0732
Mailing Address - Country:US
Mailing Address - Phone:281-684-9575
Mailing Address - Fax:719-589-2246
Practice Address - Street 1:1991 CARROLL ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2003
Practice Address - Country:US
Practice Address - Phone:719-589-4952
Practice Address - Fax:719-589-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0110549363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1457540189OtherINDIVIDUAL NPI
CO334178Medicare PIN