Basic Information
| Provider Information | |||||||||
| NPI: | 1942272919 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRAWFORD & FITCH - EAR NOSE AND THROAT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1029 LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163231242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144377266 | ||||||||
| FaxNumber: | 8144371147 | ||||||||
| Practice Location | |||||||||
| Address1: | 1029 LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163231242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144377266 | ||||||||
| FaxNumber: | 8144371147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 12/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | FRANTZ | ||||||||
| AuthorizedOfficialFirstName: | ALICE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8144377266 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 040291 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 0017984480003 | 05 | PA | MEDICAID |