MEDICARE: BRADLEY ALAN CRAWFORD IDHS

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	1710I1003X	Independent Duty Medical Technicians		TX

General Provider Information

NPI Number	:	1295699544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY ALAN CRAWFORD IDHS

Provider Business Mailing Address
First Line	:	2901 TURTLE CREEK DR STE 200
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-8067
Country	:	US
Telephone Number	:	419-670-4120
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 TURTLE CREEK DR STE 200
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-8067
Country	:	US
Telephone Number	:	419-670-4120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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