MEDICARE: BILL CROW, CRNA, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	73665	OK

General Provider Information

NPI Number	:	1255840658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BILL CROW, CRNA, PC

Provider Business Mailing Address
First Line	:	4131 NW 122ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8869
Country	:	US
Telephone Number	:	405-775-9350
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 N OAK GROVE RD
Second Line	:
City	:	DRUMRIGHT
State	:	OK
Zip	:	74030-5660
Country	:	US
Telephone Number	:	918-549-5596
Fax Number	:

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	BILLY D CROW
Credential	:
Telephone Number	:	918-549-5596

Provider Enumeration Date	:	09/28/2017
Last Update Date	:	09/28/2017

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