Provider Demographics
NPI:1750661138
Name:C & S FAMILY MEDICAL
Entity Type:Organization
Organization Name:C & S FAMILY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, FNP-BC
Authorized Official - Phone:573-785-4600
Mailing Address - Street 1:65 COUNTY ROAD 527
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-8029
Mailing Address - Country:US
Mailing Address - Phone:573-785-4600
Mailing Address - Fax:573-785-3611
Practice Address - Street 1:65 COUNTY ROAD 527
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-8029
Practice Address - Country:US
Practice Address - Phone:573-785-4600
Practice Address - Fax:573-785-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN135427261QR1300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO793830Medicare Oscar/Certification