Healthcare Provider Details

I. General information

NPI: 1881759488
Provider Name (Legal Business Name): M. C. CRONEN & ASSOCIATES INC., PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 WHITTINGTON PKWY
LOUISVILLE KY
40222-4904
US

IV. Provider business mailing address

PO BOX 26798
BELFAST ME
04915-2018
US

V. Phone/Fax

Practice location:
  • Phone: 502-423-7246
  • Fax: 502-292-5755
Mailing address:
  • Phone: 502-423-7246
  • Fax: 502-292-5755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: DR. MICHAEL C CRONEN
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 502-423-7246