1295731917 NPI number — MS. ANN J STROCK CRNA

Table of content: MS. ANN J STROCK CRNA (NPI 1295731917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295731917 NPI number — MS. ANN J STROCK CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STROCK
Provider First Name:
ANN
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1295731917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3559
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUWANEE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30024-0993
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-979-9996
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 MEDICAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SNELLVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30078-2195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-979-9996
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2005

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: 367500000X , with the licence number:  84532 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: RN154095 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 274911 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8051846 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104691875 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1562432 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 794273 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: GAN375 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00126662 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100851390A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 136523701 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2460555 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 913914115 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3496653 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 422400000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8949531 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200381360A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4303416 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 172580601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200457710A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com