1568662534 NPI number — MS. SEAHEART CRUMPTON ELAN LMT-OR(ADD);LMP-WA(I

Table of content: MS. SEAHEART CRUMPTON ELAN LMT-OR(ADD);LMP-WA(I (NPI 1568662534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568662534 NPI number — MS. SEAHEART CRUMPTON ELAN LMT-OR(ADD);LMP-WA(I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELAN
Provider First Name:
SEAHEART
Provider Middle Name:
CRUMPTON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMT-OR(ADD);LMP-WA(I
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROSS
Provider Other First Name:
DORIS
Provider Other Middle Name:
CRUMPTON
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMP-WA(INACTIVE)
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568662534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2588
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALDPORT
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-563-8333
Provider Business Mailing Address Fax Number:
360-385-2117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
539 MOFFITT ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALDPORT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-563-8333
Provider Business Practice Location Address Fax Number:
360-385-2117
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: 174400000X , with the licence number:  MA00010469 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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