1386645141 NPI number — DR. LOUIS GREENE STANFIELD II CRNA, PHD

Table of content: DR. LOUIS GREENE STANFIELD II CRNA, PHD (NPI 1386645141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386645141 NPI number — DR. LOUIS GREENE STANFIELD II CRNA, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STANFIELD
Provider First Name:
LOUIS
Provider Middle Name:
GREENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
Provider Credential Text:
CRNA, PHD
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:
1386645141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
63 FERRIS LANE
Provider Second Line Business Mailing Address:
UNIT K6
Provider Business Mailing Address City Name:
BARRIE
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
L4M5C4
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
651-270-6849
Provider Business Mailing Address Fax Number:
800-631-6136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1730 GRAHAM AVE
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55116-3090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-270-6849
Provider Business Practice Location Address Fax Number:
800-631-6136
Provider Enumeration Date:
08/02/2005

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:  R1386176 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CB8050K , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39723 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 430003046 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: R20876 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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