1497890115 NPI number — DR. JASON MICHAEL CROUCH D.O.

Table of content: DR. JASON MICHAEL CROUCH D.O. (NPI 1497890115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497890115 NPI number — DR. JASON MICHAEL CROUCH D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROUCH
Provider First Name:
JASON
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1497890115
Entity Type Code:
Individual
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:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , 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: 200116510 A . This is a "MEDICAID # FOR CROUCH FAMILY MEDICINE (CLINIC)" identifier , issued by the state of ( OK ) . 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: 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: 200116510A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6147210001 . This is a "DURABLE MEDICAL EQUIPMENT (DME) PTAN" 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: 200116520A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300522328 . This is a "MEDICARE # FOR CROUCH FAMILY MEDICINE (CLINIC)" 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".
  • Identifier: 1609093228 . This is a "NPI FOR CROUCH FAMILY MEDICINE PC (ORGANIZATION NPI)" 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: 1497890115 . This is a "NPI FOR JASON CROUCH, D.O." identifier . This identifiers is of the category "OTHER".
  • Identifier: 200116520 A . This is a "MEDICAID # FOR JASON CROUCH, D.O." identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 4474235 . This is a "CIGNA HEALTHCARE PROVIDER #" identifier . This identifiers is of the category "OTHER".




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