1295926590 NPI number — CRESCENT MEDICAL INC.

Table of content: (NPI 1295926590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295926590 NPI number — CRESCENT MEDICAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRESCENT MEDICAL 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:
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:
1295926590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1264 WESLEY DR
Provider Second Line Business Mailing Address:
SUITE 501
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-346-1800
Provider Business Mailing Address Fax Number:
901-346-0043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1264 WESLEY DR
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-346-1800
Provider Business Practice Location Address Fax Number:
901-346-0043
Provider Enumeration Date:
08/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KATHAWALA
Authorized Official First Name:
AHSAN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
901-346-1800

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD0000028245 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000115782 . This is a "UNISON HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5009811 . This is a "MEMPHIS MANAGED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110235971 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3027560 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 607266900 . This is a "ACS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 140096001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4028944 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 8394237 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3804749 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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