Basic Information
| Provider Information | |||||||||
| NPI: | 1871522938 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DONALD E. KROUSE, M.D. INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HAYFORK HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 496084 | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960496084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302410473 | ||||||||
| FaxNumber: | 5302415377 | ||||||||
| Practice Location | |||||||||
| Address1: | 1243 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HAYFORK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 96041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306285517 | ||||||||
| FaxNumber: | 5306285524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 12/03/2007 | ||||||||
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| AuthorizedOfficialLastName: | KROUSE | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5306285517 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.