Provider Demographics
NPI:1447655915
Name:DR CROWELL INTERNAL MEDICINE PC
Entity type:Organization
Organization Name:DR CROWELL INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-350-0005
Mailing Address - Street 1:4121 SW LEEWARD DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4788
Mailing Address - Country:US
Mailing Address - Phone:816-350-0005
Mailing Address - Fax:913-851-7785
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2358
Practice Address - Country:US
Practice Address - Phone:816-350-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO247648538Medicaid
MO247648538Medicaid
MOMA3438Medicare PIN