Provider Demographics
NPI:1194092478
Name:CRENSHAW FAMILY CARE CENTER, LLC
Entity type:Organization
Organization Name:CRENSHAW FAMILY CARE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAWRENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-386-0343
Mailing Address - Street 1:PO BOX 5013
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36103-5013
Mailing Address - Country:US
Mailing Address - Phone:334-386-0343
Mailing Address - Fax:334-386-0382
Practice Address - Street 1:58 ROY BEALL DR
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-6800
Practice Address - Country:US
Practice Address - Phone:334-335-1212
Practice Address - Fax:334-335-1217
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRENSHAW FAMILY CARE CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-30
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty