1245296250 NPI number — ELLEN B CROWE MD

Table of content: ELLEN B CROWE MD (NPI 1245296250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245296250 NPI number — ELLEN B CROWE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROWE
Provider First Name:
ELLEN
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1245296250
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 LOS PADRES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THOUSAND OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91361-1317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-380-3313
Provider Business Mailing Address Fax Number:
805-449-0091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 LOS PADRES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THOUSAND OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91361-1317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-380-3313
Provider Business Practice Location Address Fax Number:
805-449-0091
Provider Enumeration Date:
04/26/2006

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: 207PE0004X , with the licence number:  01036964 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: G89024 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: P00608083 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 104748978 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000365275 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200072690 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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