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General NPI Number Information
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NPI Number | 1366602112
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Entity Type | Organization
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Legal Business Name | JOHN CRAWFORD III DO
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Dates
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Enumeration Date | 06/16/2008
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 170 FOURTH AVE
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City | HASTINGS
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State | PA
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Zip | 16646
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Country | US
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Telephone | 814-247-6583
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Fax | 814-247-8219
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Provider Business Mailing Address
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Address Line | PO BOX 629 170 FOURTH AVENUE
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City | HASTINGS
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State | PA
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Zip | 16646-0629
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Country | US
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Telephone | 814-247-6583
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Fax | 814-247-8219
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | DR. JOHN CRAWFORD III
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Credential | DO
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Telephone | 814-247-6583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 022586
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License Number State | PA
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