Provider Demographics
NPI:1942266184
Name:BEAU MCCRORY MD PA
Entity type:Organization
Organization Name:BEAU MCCRORY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CCP
Authorized Official - Phone:940-384-6238
Mailing Address - Street 1:PO BOX 2023
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76202-2023
Mailing Address - Country:US
Mailing Address - Phone:940-384-6238
Mailing Address - Fax:940-382-7680
Practice Address - Street 1:105 VALLEY FORGE ST
Practice Address - Street 2:
Practice Address - City:COMANCHE
Practice Address - State:TX
Practice Address - Zip Code:76442-1813
Practice Address - Country:US
Practice Address - Phone:325-356-7530
Practice Address - Fax:940-382-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0093JVOtherBLUE CROSS BLUE SHIELD
TX00984UMedicare ID - Type Unspecified