1467501379 NPI number — DENNIS C MCCRANEY PA-C

Table of content: DENNIS C MCCRANEY PA-C (NPI 1467501379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467501379 NPI number — DENNIS C MCCRANEY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCRANEY
Provider First Name:
DENNIS
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1467501379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1226
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37065-1226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-591-2732
Provider Business Mailing Address Fax Number:
615-591-2779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4147 HWY 127 N
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CROSSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38571-7521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-456-1223
Provider Business Practice Location Address Fax Number:
931-456-1230
Provider Enumeration Date:
01/09/2007

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: 363A00000X , with the licence number:  PA0000000918 , 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: 4141136 . This is a "BC/BS - COLUMBIA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4142236 . This is a "BC/BS - MCMINNVILLE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 36701051 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00431299 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: PA0000000918 . This is a "STATE LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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