Provider Demographics
NPI:1205881604
Name:CROUSE, LINDA J (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:J
Last Name:CROUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 GLENN HENDREN DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3388
Mailing Address - Country:US
Mailing Address - Phone:816-407-5430
Mailing Address - Fax:816-407-5435
Practice Address - Street 1:2521 GLENN HENDREN DR
Practice Address - Street 2:SUITE 306
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3388
Practice Address - Country:US
Practice Address - Phone:816-407-5430
Practice Address - Fax:816-407-5435
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0420880174400000X
MOR6E86174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202205506Medicaid
4001400OtherAETNA
KS100202600DMedicaid
MO11730067OtherBCBS OF KANSAS CITY
KS400850OtherBCBSKANSAS
MOMA1832004Medicare PIN
C50775Medicare UPIN
4001400OtherAETNA