1396711610 NPI number — JAMES R CRANDELL MD

Table of content: JAMES R CRANDELL MD (NPI 1396711610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396711610 NPI number — JAMES R CRANDELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRANDELL
Provider First Name:
JAMES
Provider Middle Name:
R
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:
1396711610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 378
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDUSKY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44871-0378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-626-6161
Provider Business Mailing Address Fax Number:
419-502-3511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25200 CENTER RIDGE RD STE 1100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTLAKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44145-4146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-331-4853
Provider Business Practice Location Address Fax Number:
440-333-7044
Provider Enumeration Date:
02/27/2006

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: 207RC0000X , with the licence number:  35059930C , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9273172 . This is a "GROUP MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: D368301 . This is a "GROUP IND DIAGNOTICS MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 109934 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0119204 . This is a "GROUP MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2448496 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: CA4511 . This is a "RR MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10790137 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110213802 . This is a "RR MEDICARE INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3610861 . This is a "GROUP ASC MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: L59930 . This is a "SUMMACARE APEX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 341783789055 . This is a "CARESOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000188027 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1780634279 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: CA4511 . This is a "GROUP RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0805436 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2502257 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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