1619972619 NPI number — CRR ENTERPRISES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619972619 NPI number — CRR ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRR ENTERPRISES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1619972619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1336
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75951-0014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-384-5570
Provider Business Mailing Address Fax Number:
409-755-6030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 E GIBSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75951-5105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-384-5570
Provider Business Practice Location Address Fax Number:
409-384-4042
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
READ
Authorized Official First Name:
CLAUDETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
409-384-5570

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AMB584 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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