Provider Demographics
NPI:1730223801
Name:CRAWFORD COUNTY ENT PC
Entity type:Organization
Organization Name:CRAWFORD COUNTY ENT PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-373-3070
Mailing Address - Street 1:505 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3057
Mailing Address - Country:US
Mailing Address - Phone:814-373-3070
Mailing Address - Fax:814-373-3074
Practice Address - Street 1:505 POPLAR ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3057
Practice Address - Country:US
Practice Address - Phone:814-373-3070
Practice Address - Fax:814-373-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046736L207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012963010001Medicaid
PA079117OtherMEDICARE PTAN
PAF35788Medicare UPIN