Provider Demographics
NPI:1881759488
Name:M. C. CRONEN & ASSOCIATES INC., PSC
Entity type:Organization
Organization Name:M. C. CRONEN & ASSOCIATES INC., PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:CRONEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:502-423-7246
Mailing Address - Street 1:PO BOX 26798
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2018
Mailing Address - Country:US
Mailing Address - Phone:502-423-7246
Mailing Address - Fax:502-292-5755
Practice Address - Street 1:252 WHITTINGTON PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4904
Practice Address - Country:US
Practice Address - Phone:502-423-7246
Practice Address - Fax:502-292-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207LP2900X, 208VP0014X
332B00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4891Medicare PIN
KY5296Medicare PIN