1366602112 NPI number — JOHN CRAWFORD III DO

Table of content: (NPI 1366602112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366602112 NPI number — JOHN CRAWFORD III DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN CRAWFORD III DO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1366602112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 629
Provider Second Line Business Mailing Address:
170 FOURTH AVENUE
Provider Business Mailing Address City Name:
HASTINGS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16646-0629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-247-6583
Provider Business Mailing Address Fax Number:
814-247-8219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 FOURTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HASTINGS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-247-6583
Provider Business Practice Location Address Fax Number:
814-247-8219
Provider Enumeration Date:
06/16/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CRAWFORD
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
LAB DIRECTOR
Authorized Official Telephone Number:
814-247-6583

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  022586 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0005860850001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84604 . This is a "UNISON LABORATORY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015339070001 . This is a "MEDICAID LABORATORY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".