CRYSTAL STONE LTD NPI 1619409075

NPI Information

NPI: 1619409075
Provider Name: CRYSTAL STONE LTD

Doing Business As: NEW LEAF PRIMARY CARE

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
423 N HIGH ST
BELLEVILLE, IL
ZIP 62220
Phone: (618) 806-7939
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CRYSTAL STONE LTD is a primary care clinic center in Belleville, IL. CRYSTAL STONE LTD NPI is 1619409075. The provider is registered as an organization entity type.
The provider Is Doing Business As New Leaf Primary Care.

The provider's business location address is:

423 N HIGH ST
BELLEVILLE, IL
ZIP 62220-214
Phone: (618) 806-7939
Fax: (877) 295-7244

The provider's authorized official is Crystal Stone .
The authorized official title is Ceo and has the following contact phone number (618) 416-7738.

The CLIA number assigned to this NPI record is 14D2136480 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/3/2017 and was last updated on 7/28/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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