| Crouch Family Medicine Pc | |
|
806 Manvel Ave Chandler OK 74834-3858 | |
| (405) 258-9955 | |
| (405) 258-9930 |
| Full Name | Crouch Family Medicine Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 806 Manvel Ave, Chandler, Oklahoma |
| Authorized Official Name and Position | Robin Lee Crouch (BUSINESS MANAGER) |
| Authorized Official Contact | 4052589955 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crouch Family Medicine Pc 806 Manvel Ave Chandler OK 74834-3858 Ph: (405) 258-9955 | Crouch Family Medicine Pc 806 Manvel Ave Chandler OK 74834-3858 Ph: (405) 258-9955 |
| NPI Number | 1609093228 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 03/04/2013 |
| Medicare PECOS PAC ID | 2062503709 |
|---|---|
| Medicare Enrollment ID | O20070809000201 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609093228 | NPI | - | NPPES |
| 6147210001 | Other | OK | PTAN |
| 9060050 | Other | AETNA PIN | |
| 1618242 | Other | COVENTRY HEALTH CARE PROVIDER ID # | |
| 37D1067992 | Other | CLIA # FOR CROUCH FAMILY MEDICINE LAB (CLIA-WAIVED LAB) | |
| 200116520A | Other | OK | MEDICAID # FOR JASON CROUCH, D.O. |
| 200116520A | Medicaid | OK | |
| OKA104243 | Other | MEDICARE PTAN FOR JANENA MILBURN, APRN, CNP, FNP-C | |
| P00465778 | Other | RAILROAD MEDICARE PT. B PTAN | |
| 1215222666 | Other | NPI FOR JANENA MILBURN, APRN, CNP, FNP-C | |
| 1497890115 | Other | NPI FOR JASON CROUCH, D.O. (INDIVIDUAL) | |
| 4474235 | Other | CIGNA HEALTHCARE PROVIDER # | |
| 1609093228 | Other | NPI FOR CROUCH FAMILY MEDICINE (ORGANIZATION) | |
| 243722101 | Other | MEDICARE # FOR JASON CROUCH, D.O. | |
| 300522328 | Other | MEDICARE # FOR CROUCH FAMILY MEDICINE PC | |
| 200116510A | Other | OK | MEDICAID # FOR CROUCH FAMILY MEDICINE PC |
| 200116510A | Medicaid | OK | |
| 6147210001 | Other | DME PTAN FOR CROUCH FAMILY MEDICINE | |
| DG9878 | Other | RAILROAD MEDICARE PT. B GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 4290 (Oklahoma) | Primary |
| Provider Name | Jason M Crouch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497890115 PECOS PAC ID: 7517058241 Enrollment ID: I20070809000112 |
| Provider Name | Janena G Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215222666 PECOS PAC ID: 8426213968 Enrollment ID: I20120706000253 |
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