Organization
CRENSHAW FAMILY PRACTICE CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NEVILLE Q. CRENSHAW DO (OWNER)
(660) 727-3388
Entity
Organization
Contact information
Practice address
133 E MAIN, KAHOKA, MO 63445-1775
(660) 727-3388
(660) 727-2196
Mailing address
133 E MAIN, KAHOKA, MO 63445
(660) 727-3388
(660) 727-2196
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000002704
MEDICARE GROUP NUMBER
MO
05
—
242028900
—
MO
Enumeration date
04/17/2007
Last updated
01/15/2013
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