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NPI Code Detail

MEDICARE: JAMES WINFIELD CREW III BS, CADCII

MEDICARE:   JAMES WINFIELD CREW III BS, CADCII
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
1101YA0400XAddiction (Substance Use Disorder) Counselor13-03-45UOR

General Provider Information

NPI Number : 1770072589
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES WINFIELD CREW III BS, CADCII
Provider Business Mailing Address
First Line : 332 SW COAST HWY
Second Line :
City : NEWPORT
State : OR
Zip : 97365-4928
Country : US
Telephone Number : 541-574-9050
Fax Number : 541-574-9052
Provider Business Practice Location Address
First Line : 332 SW COAST HWY
Second Line :
City : NEWPORT
State : OR
Zip : 97365-4928
Country : US
Telephone Number : 541-574-9050
Fax Number : 541-574-9052
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2018
Last Update Date : 05/07/2018

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