Clint A Crouse
Individual provider Active NPI Driver · Walterboro, SC
NPI 1376611657 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1376611657
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- Practice address
- 483 Dantzler LN
Walterboro, SC 29488-8986 - Phone
- (843) 844-2124
- NPI assigned
- Dec 2, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | Yes |
Addresses
Primary practice location
483 Dantzler LN
Walterboro, SC 29488-8986
Mailing address
483 Dantzler LN
Walterboro, SC 29488-8986
Other providers in Walterboro, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.