1609093228 NPI number — CROUCH FAMILY MEDICINE PC

Table of content: (NPI 1609093228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609093228 NPI number — CROUCH FAMILY MEDICINE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROUCH FAMILY MEDICINE PC
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:
1609093228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
806 MANVEL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74834-3858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-258-9955
Provider Business Mailing Address Fax Number:
405-258-9930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 MANVEL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74834-3858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-258-9955
Provider Business Practice Location Address Fax Number:
405-258-9930
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CROUCH
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
405-258-9955

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  4290 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6147210001 . This is a "PTAN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 9060050 . This is a "AETNA PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1618242 . This is a "COVENTRY HEALTH CARE PROVIDER ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 37D1067992 . This is a "CLIA # FOR CROUCH FAMILY MEDICINE LAB (CLIA-WAIVED LAB)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200116520A . This is a "MEDICAID # FOR JASON CROUCH, D.O." identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200116520A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: OKA104243 . This is a "MEDICARE PTAN FOR JANENA MILBURN, APRN, CNP, FNP-C" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00465778 . This is a "RAILROAD MEDICARE PT. B PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1215222666 . This is a "NPI FOR JANENA MILBURN, APRN, CNP, FNP-C" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1497890115 . This is a "NPI FOR JASON CROUCH, D.O. (INDIVIDUAL)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4474235 . This is a "CIGNA HEALTHCARE PROVIDER #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1609093228 . This is a "NPI FOR CROUCH FAMILY MEDICINE (ORGANIZATION)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 243722101 . This is a "MEDICARE # FOR JASON CROUCH, D.O." identifier . This identifiers is of the category "OTHER".
  • Identifier: 300522328 . This is a "MEDICARE # FOR CROUCH FAMILY MEDICINE PC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200116510A . This is a "MEDICAID # FOR CROUCH FAMILY MEDICINE PC" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200116510A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6147210001 . This is a "DME PTAN FOR CROUCH FAMILY MEDICINE" identifier . This identifiers is of the category "OTHER".
  • Identifier: DG9878 . This is a "RAILROAD MEDICARE PT. B GROUP NUMBER" identifier . This identifiers is of the category "OTHER".




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