1356685499 NPI number — MR. ALLEN WAYNE CROWDER P.A.

Table of content: MR. ALLEN WAYNE CROWDER P.A. (NPI 1356685499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356685499 NPI number — MR. ALLEN WAYNE CROWDER P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROWDER
Provider First Name:
ALLEN
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1356685499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2331 FRANKLIN RD SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24014-1111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-725-1226
Provider Business Mailing Address Fax Number:
540-857-5306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2331 FRANKLIN RD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24014-1111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-725-1226
Provider Business Practice Location Address Fax Number:
540-857-5306
Provider Enumeration Date:
11/15/2012

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:  0110004077 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: 0110004077 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1356685499 . This is a "ANTHEM MEDIGAP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356685499 . This is a "CCC VIRGINIA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356685499 . This is a "OPTIMA HEALTH PLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356685499 . This is a "MEDICAID QMB" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356685499 . This is a "HUMANA MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 371194700 . This is a "BLACK LUNG" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P01201634 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356685499 . This is a "SOUTHERN HEALTH/CARENET/CARELINK/COVENTRY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356685499 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356685499 . This is a "INTOTAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356685499 . This is a "UMWA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356685499 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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