# GLENN CROWSON MD INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wewoka Medical Rural Health Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033103452
- **Authorized official:** DR. GLENN ALVIN CROWSON MD (CEO)
- **Authorized official phone:** (405) 257-3396

## Contact information

- **Practice address:** 1401 W 1ST ST, WEWOKA, OK 74884-5097
- **Practice address phone:** (405) 257-3396
- **Practice address fax:** (405) 257-6908
- **Mailing address:** PO BOX 1093, WEWOKA, OK 74884-1093
- **Mailing address phone:** (405) 257-3396
- **Mailing address fax:** (405) 257-6908

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 13854 | OK | — |
| 261QR1300X | Rural Health Clinic/Center | 13854 | OK | Yes |
| 363L00000X | Nurse Practitioner | R0073222 | OK | — |

## Other

- **Enumeration date:** 08/31/2005
- **Last updated:** 06/11/2015