Active NPI
Samuel Phillip Prince, PTA
- Pediatric Rehabilitation Medicine Physician
- Amarillo, TX
National Provider Identifier
1619683489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Rehabilitation Medicine Physician
- License
- 2012688
- Practice address
- 3304 Westlawn St
Amarillo, TX 79102-2012 - Phone
- (505) 604-4151
- NPI assigned
- Jan 25, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Rehabilitation Medicine Physician | 2081P0010X | 2012688 | TX | Primary |
Addresses
Primary practice location
3304 Westlawn St
Amarillo, TX 79102-2012
Mailing address
3304 Westlawn St
Amarillo, TX 79102-2012
Phone (505) 604-4151
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2012688 | TX | MD | Pediatric Rehabilitation Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674604800000",
"number": "1619683489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3304 WESTLAWN ST",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791022012",
"telephone_number": "505-604-4151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3304 WESTLAWN ST",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791022012",
"telephone_number": "505-604-4151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRINCE",
"first_name": "SAMUEL",
"middle_name": "PHILLIP",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-25",
"last_updated": "2023-01-25",
"certification_date": "2023-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "2081P0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
"state": "TX",
"license": "2012688",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Amarillo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.