MEDICARE: SUE ELLA CROW MD

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	H2321	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	380000649	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00681R	OTHER	TX	BLUE CROSS BLUE SHEILD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	8446N0	OTHER	TX	BLUE CROSS BLUE SHIELD
6	8K9696	OTHER	TX	PRINCETON MEDICAL GROUP PA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386653442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE ELLA CROW MD

Provider Business Mailing Address
First Line	:	14100 NACOGDOCHES RD
Second Line	:	STE 116
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1903
Country	:	US
Telephone Number	:	210-653-8989
Fax Number	:	210-590-4608

Provider Business Practice Location Address
First Line	:	14100 NACOGDOCHES RD
Second Line	:	STE 116
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1903
Country	:	US
Telephone Number	:	210-653-8989
Fax Number	:	210-590-4608

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	01/30/2013

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Directions to “ SUE ELLA CROW MD” Practice Location

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