Provider Demographics
NPI:1053580167
Name:CROW CREEK THERAPEUTICS, LLC
Entity type:Organization
Organization Name:CROW CREEK THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-420-2337
Mailing Address - Street 1:580 S HIGH ST
Mailing Address - Street 2:STE 230
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5644
Mailing Address - Country:US
Mailing Address - Phone:888-420-2337
Mailing Address - Fax:866-228-9250
Practice Address - Street 1:1740 HARMON AVE
Practice Address - Street 2:STE H
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-3355
Practice Address - Country:US
Practice Address - Phone:888-420-2337
Practice Address - Fax:866-228-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1752867332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000581418OtherANTHEM
OH2850197Medicaid
OH6106520001Medicare NSC