MEDICARE: MR. DOUGLAS R CROUCH

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	171WH0202X	Home Modifications Contractor

General Provider Information

NPI Number	:	1457577918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS R CROUCH

Provider Business Mailing Address
First Line	:	3437 VALLEY VIEW DR
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-7711
Country	:	US
Telephone Number	:	515-419-9549
Fax Number	:

Provider Business Practice Location Address
First Line	:	3437 VALLEY VIEW DR
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-7711
Country	:	US
Telephone Number	:	515-419-9549
Fax Number	:

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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