Basic Information
| Provider Information | |||||||||
| NPI: | 1346704285 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROUCH | ||||||||
| FirstName: | CHAD | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | CRNA, MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2940 COOK RD | ||||||||
| Address2: | |||||||||
| City: | ROOTSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442729748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306311217 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13207 RAVENNA RD | ||||||||
| Address2: | |||||||||
| City: | CHARDON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440247032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402856000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2019 | ||||||||
| LastUpdateDate: | 01/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 019827 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.