1124616487 NPI number — TARA RENEE CROTTS HEARING INSTRUMENT S

Table of content: TARA RENEE CROTTS HEARING INSTRUMENT S (NPI 1124616487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124616487 NPI number — TARA RENEE CROTTS HEARING INSTRUMENT S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROTTS
Provider First Name:
TARA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HEARING INSTRUMENT S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIVETT
Provider Other First Name:
TARA
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
HEARING INSTRUMENT S
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124616487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
423 SOUTH KING STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-438-9685
Provider Business Mailing Address Fax Number:
828-391-5024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
423 SOUTH KING STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-438-9685
Provider Business Practice Location Address Fax Number:
828-391-5024
Provider Enumeration Date:
01/04/2021

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: 237700000X , with the licence number:  1178A01 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: 1635 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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