1184666927 NPI number — DOUGLAS F CRANE MD

Table of content: DOUGLAS F CRANE MD (NPI 1184666927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184666927 NPI number — DOUGLAS F CRANE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRANE
Provider First Name:
DOUGLAS
Provider Middle Name:
F
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:
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:
1184666927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
164 WACCAMAW MEDICAL PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29526-8903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-347-5060
Provider Business Mailing Address Fax Number:
843-347-3959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 WAPPOO CREEK DR
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29412-2134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-795-3585
Provider Business Practice Location Address Fax Number:
843-795-9728
Provider Enumeration Date:
06/12/2006

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: 2084A0401X , with the licence number:  7808 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 7808 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0802X , with the licence number: 7808 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 078089 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5866 . This is a "MEDICARE PIN FOR LOWCOUNTRY PSYCHOTHERAPY ASSOCIATES" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 7808 . This is a "LICENSE NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 030740 . This is a "PHYSICIAN LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 3344 . This is a "MEDICARE PIN WACCAMAW CENTER FOR MENTAL HEALTH" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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