Provider Demographics
NPI:1003119595
Name:SARA E. CROWDER, MD
Entity Type:Organization
Organization Name:SARA E. CROWDER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-442-2221
Mailing Address - Street 1:1605 E BROADWAY STE 260
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8044
Mailing Address - Country:US
Mailing Address - Phone:573-442-2221
Mailing Address - Fax:573-449-8646
Practice Address - Street 1:1605 E BROADWAY STE 220
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8023
Practice Address - Country:US
Practice Address - Phone:573-442-2221
Practice Address - Fax:573-449-8646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002015736174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205887912Medicaid
MO205887912Medicaid
MO000095947Medicare PIN