MEDICARE: JEROME R CRANE PA

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	363A00000X	Physician Assistant	PA01073	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1A3305	OTHER	TX	MEDICARE
3	909591	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8561ND	OTHER	TX	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	8MD176	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1942338702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME R CRANE PA

Provider Business Mailing Address
First Line	:	707 N WALDRIP ST
Second Line	:
City	:	GRAND SALINE
State	:	TX
Zip	:	75140-1555
Country	:	US
Telephone Number	:	903-913-6300
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 N WALDRIP ST
Second Line	:
City	:	GRAND SALINE
State	:	TX
Zip	:	75140-1555
Country	:	US
Telephone Number	:	903-962-4242
Fax Number	:	903-962-7799

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	12/16/2022

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Directions to “ JEROME R CRANE PA” Practice Location

Language	Start Address	Practice Location

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