1225238215 NPI number — RICHARD (RICK) LYNN CROWNOVER MD

Table of content: RICHARD (RICK) LYNN CROWNOVER MD (NPI 1225238215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225238215 NPI number — RICHARD (RICK) LYNN CROWNOVER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROWNOVER
Provider First Name:
RICHARD (RICK)
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1225238215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4301 W MARKHAM ST # 783
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-7101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-686-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1455 HIGDON FERRY RD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71913-6456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-622-2100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2007

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: 2085R0001X , with the licence number:  E-13696 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0001X , with the licence number: N1596 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 188851304 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 188851302 . This is a "CSN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8AM490 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 188851301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 188851305 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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