Provider Demographics
NPI:1487713400
Name:DR. JAMES M CROAK, INC.
Entity type:Organization
Organization Name:DR. JAMES M CROAK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:CROAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-893-7134
Mailing Address - Street 1:28442 E RIVER RD STE 111
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2795
Mailing Address - Country:US
Mailing Address - Phone:419-893-7134
Mailing Address - Fax:419-893-6942
Practice Address - Street 1:28442 E RIVER RD STE 111
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2795
Practice Address - Country:US
Practice Address - Phone:419-893-7134
Practice Address - Fax:419-893-6942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207VG0400X, 208800000X
OH07610-NP363LW0102X
OHNP-01213363LW0102X
OHCOA-16001363LX0001X
OH34-00-6843-C207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Single Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2476815Medicaid
OHJA9344411Medicare PIN