1700129376 NPI number — MR. JAMES CRAWFORD ICS

Table of content: MR. JAMES CRAWFORD ICS (NPI 1700129376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700129376 NPI number — MR. JAMES CRAWFORD ICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAWFORD
Provider First Name:
JAMES
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ICS
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:
1700129376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1213 N SHERMAN AVE # 323
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53704-4236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-445-4886
Provider Business Mailing Address Fax Number:
608-467-9135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4222 MILWAUKEE ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53714-3534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-467-9134
Provider Business Practice Location Address Fax Number:
608-467-9135
Provider Enumeration Date:
04/02/2013

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: 101YA0400X , with the licence number:  14524-132 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: 15371-135 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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