NPIMap

Organization Active NPI

Glenn Crowson MD Inc

  • Rural Health Clinic/Center
  • Wewoka, OK
National Provider Identifier
1033103452
Registry record updated Jun 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
13854 Issued in OK
Legal business name
GLENN CROWSON MD INC
Practice address
1401 W 1St St
Wewoka, OK 74884-5097
Phone
(405) 257-3396
Fax
(405) 257-6908
NPI assigned
Aug 31, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Glenn Alvin Crowson, MD
Title
Ceo
Phone
(405) 257-3396

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 13854 OK
Rural Health Clinic/Center 261QR1300X 13854 OK Primary
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X R0073222 OK

Addresses

Primary practice location

1401 W 1St St
Wewoka, OK 74884-5097

Mailing address

PO Box 1093
Wewoka, OK 74884-1093
Phone (405) 257-3396

Other identifiers 4

IdentifierTypeStateIssuer
100740370BMedicaidOK
100156370AMedicaidOK
200015980AMedicaidOK
100740370CMedicaidOK

Other names 1

  • Wewoka Medical Rural Health Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433980800000",
    "number": "1033103452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1093",
            "city": "WEWOKA",
            "state": "OK",
            "postal_code": "748841093",
            "telephone_number": "405-257-3396",
            "fax_number": "405-257-6908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 W 1ST ST",
            "city": "WEWOKA",
            "state": "OK",
            "postal_code": "748845097",
            "telephone_number": "405-257-3396",
            "fax_number": "405-257-6908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN CROWSON MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-31",
        "last_updated": "2015-06-11",
        "status": "A",
        "authorized_official_last_name": "CROWSON",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "ALVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-257-3396",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "13854",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "OK",
            "license": "13854",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "OK",
            "license": "R0073222",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100740370B",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100156370A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200015980A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100740370C",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wewoka Medical Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wewoka, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.