Basic Information
| Provider Information | |||||||||
| NPI: | 1205881604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROUSE | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2521 GLENN HENDREN DR | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | LIBERTY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640683388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164075430 | ||||||||
| FaxNumber: | 8164075435 | ||||||||
| Practice Location | |||||||||
| Address1: | 2521 GLENN HENDREN DR | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | LIBERTY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640683388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164075430 | ||||||||
| FaxNumber: | 8164075435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 11/11/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0420880 | KS | N | Other Service Providers | Specialist | 174400000X | R6E86 | MO | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 202205506 | 05 | MO | MEDICAID | 4001400 | 01 | AETNA | OTHER | 100202600D | 05 | KS | MEDICAID | 11730067 | 01 | MO | BCBS OF KANSAS CITY | OTHER | 400850 | 01 | KS | BCBSKANSAS | OTHER |