1356422554 NPI number — MR. CRANFORD RICHARD POWELL PA-C

Table of content: MR. CRANFORD RICHARD POWELL PA-C (NPI 1356422554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356422554 NPI number — MR. CRANFORD RICHARD POWELL PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWELL
Provider First Name:
CRANFORD
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

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:
1356422554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1155 THICKET CT APT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47201-9700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-343-5512
Provider Business Mailing Address Fax Number:
317-481-6629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2555 KENTUCKY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46221-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-481-6626
Provider Business Practice Location Address Fax Number:
317-481-6629
Provider Enumeration Date:
10/17/2006

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: 363AM0700X , with the licence number:  PA000033-46 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 10001530A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10001530A . This is a "PA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: PA000033-46 . This is a "PA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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