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NPI Code Detail

MEDICARE: DAVID C CROWDER CRNA

MEDICARE: DAVID C CROWDER CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse1059868KY
2367500000XCertified Registered Nurse Anesthetist3001954KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609876416
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID C CROWDER CRNA
Provider Business Mailing Address
First Line : PO BOX 70354
Second Line :
City : LOUISVILLE
State : KY
Zip : 40270-0354
Country : US
Telephone Number : 502-473-2132
Fax Number : 502-459-0923
Provider Business Practice Location Address
First Line : 4000 KRESGE WAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40207-4605
Country : US
Telephone Number : 502-473-2132
Fax Number : 502-459-0923
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2005
Last Update Date : 10/23/2015

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