Provider Demographics
NPI:1932769825
Name:CRENSHAW OCCUPATIONAL PRACTICE, PLLC
Entity type:Organization
Organization Name:CRENSHAW OCCUPATIONAL PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTANAIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-487-0807
Mailing Address - Street 1:5030 CRENSHAW RD STE 124
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3141
Mailing Address - Country:US
Mailing Address - Phone:281-487-0807
Mailing Address - Fax:281-487-0806
Practice Address - Street 1:5030 CRENSHAW RD STE 124
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3141
Practice Address - Country:US
Practice Address - Phone:281-487-0807
Practice Address - Fax:281-487-0806
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PCP ASSOCIATES OF PASADENA PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043003501Medicaid
TX114731602Medicaid
TX181889001Medicaid