1003119595 NPI number — SARA E. CROWDER, MD

Table of content: (NPI 1003119595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003119595 NPI number — SARA E. CROWDER, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SARA E. CROWDER, MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003119595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1605 E BROADWAY STE 260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65201-8044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-442-2221
Provider Business Mailing Address Fax Number:
573-449-8646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1605 E BROADWAY STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65201-8023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-442-2221
Provider Business Practice Location Address Fax Number:
573-449-8646
Provider Enumeration Date:
12/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CROWDER
Authorized Official First Name:
SARA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
573-442-2221

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  2002015736 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 205887912 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com