1598879314 NPI number — WILLIAM PRYOR CROOKS MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598879314 NPI number — WILLIAM PRYOR CROOKS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROOKS
Provider First Name:
WILLIAM
Provider Middle Name:
PRYOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROOKS
Provider Other First Name:
BILL
Provider Other Middle Name:
PRYOR
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1598879314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 SOUTH 28TH AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HATTIESBURG
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39401-7246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-765-4414
Provider Business Mailing Address Fax Number:
601-765-9141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
704 FIFTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLINS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-765-4414
Provider Business Practice Location Address Fax Number:
601-765-9141
Provider Enumeration Date:
08/18/2006

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: 207Q00000X , with the licence number:  13363 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00111248 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1111821 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1559275 . This is a "AMERICAN ADMIN GROUP" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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