Jack L. Croughan Inc

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

R5543 Issued in MO

Legal business name

JACK L. CROUGHAN INC

Practice address

1034 S Brentwood Blvd
Suite 970
Saint Louis, MO 63117-1223

Phone

(314) 725-4004

Fax

(314) 725-4004

NPI assigned

Mar 18, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Jack Lester Croughan, MD

Title

President

Phone

(314) 725-4004

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1268870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268870400000",
    "number": "1982928065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 S BRENTWOOD BLVD",
            "address_2": "SUITE 970",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631171223",
            "telephone_number": "314-725-4004",
            "fax_number": "314-725-4004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 S BRENTWOOD BLVD",
            "address_2": "SUITE 970",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631171223",
            "telephone_number": "314-725-4004",
            "fax_number": "314-725-4004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK L. CROUGHAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-18",
        "last_updated": "2010-03-18",
        "status": "A",
        "authorized_official_last_name": "CROUGHAN",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "LESTER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-725-4004",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "MO",
            "license": "R5543",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "R5543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melody Jablonski, NP-C
• Raggad Jabr, RN
• Besher Jabri
• Alivia Jachimiak, STUDENT
• Carolyn M Jachna, MD
• Jack M. Marincel, D.D.S., P.C.
• Jack W. Haney, D.D.S., P.C.
• Jennifer Joy Jacklin, CPNP
• Briana Jackowski, PA-C
• Rosa J Jacks-Loya, LPC

• Psychiatry Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2010; 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.