1144322835 NPI number — MS. MEGAN CROREY P.A.

Table of content: MS. MEGAN CROREY P.A. (NPI 1144322835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144322835 NPI number — MS. MEGAN CROREY P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROREY
Provider First Name:
MEGAN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144322835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 NE MOTHER JOSEPH PL
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98664-3299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-254-6161
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 NE MOTHER JOSEPH PL
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664-3299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-254-6161
Provider Business Practice Location Address Fax Number:
360-449-1139
Provider Enumeration Date:
09/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  PA161381 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA60635636 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1144322835 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500660065 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".