NPIMap

Organization Active NPI

Crenshaw Family Practice Clinic, PC

  • Family Medicine Physician
  • Kahoka, MO
National Provider Identifier
1073739439
Registry record updated Jan 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CRENSHAW FAMILY PRACTICE CLINIC, PC
Practice address
133 E Main
Kahoka, MO 63445-1775
Phone
(660) 727-3388
Fax
(660) 727-2196
NPI assigned
Apr 17, 2007
Last updated
Jan 15, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2013

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

Authorized official

Name
Neville Q. Crenshaw, DONPI 1316994783
Title
Owner
Phone
(660) 727-3388

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

133 E Main
Kahoka, MO 63445-1775

Mailing address

133 E Main
Kahoka, MO 63445
Phone (660) 727-3388

Other identifiers 2

IdentifierTypeStateIssuer
000002704OtherMOMEDICARE GROUP NUMBER
242028900MedicaidMO

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358208000000",
    "number": "1073739439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 E MAIN",
            "city": "KAHOKA",
            "state": "MO",
            "postal_code": "63445",
            "telephone_number": "660-727-3388",
            "fax_number": "660-727-2196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 E MAIN",
            "city": "KAHOKA",
            "state": "MO",
            "postal_code": "634451775",
            "telephone_number": "660-727-3388",
            "fax_number": "660-727-2196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRENSHAW FAMILY PRACTICE CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2013-01-15",
        "status": "A",
        "authorized_official_last_name": "CRENSHAW",
        "authorized_official_first_name": "NEVILLE",
        "authorized_official_middle_name": "Q.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "660-727-3388",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "000002704",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "242028900",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kahoka, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2013; 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.