Provider Demographics
NPI:1780692301
Name:WJ AND K CROWDUS
Entity type:Organization
Organization Name:WJ AND K CROWDUS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWDUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-772-4999
Mailing Address - Street 1:3224 COMMERCE CENTER PL # A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-1900
Mailing Address - Country:US
Mailing Address - Phone:502-772-4999
Mailing Address - Fax:502-772-4980
Practice Address - Street 1:3224 COMMERCE CENTER PL # A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1900
Practice Address - Country:US
Practice Address - Phone:502-772-4999
Practice Address - Fax:502-772-4980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90002569Medicaid
KY90002569Medicaid