1831330968 NPI number — MARY ANNE CRAWFORD DC LLC

Table of content: (NPI 1831330968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831330968 NPI number — MARY ANNE CRAWFORD DC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY ANNE CRAWFORD DC LLC
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:
1831330968
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2997 CAPE HORN RD
Provider Second Line Business Mailing Address:
SUITE 3A
Provider Business Mailing Address City Name:
RED LION
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17356-9327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-244-5555
Provider Business Mailing Address Fax Number:
717-244-6123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2997 CAPE HORN RD
Provider Second Line Business Practice Location Address:
SUITE 3A
Provider Business Practice Location Address City Name:
RED LION
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17356-9327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-244-5555
Provider Business Practice Location Address Fax Number:
717-244-6123
Provider Enumeration Date:
03/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CRAWFORD
Authorized Official First Name:
MARY ANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
LLC MEMBER
Authorized Official Telephone Number:
717-244-5555

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC-002834-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 454908 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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