Basic Information
| Provider Information | |||||||||
| NPI: | 1477580967 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRENSHAW | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | HARDY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 843966 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641843966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738843300 | ||||||||
| FaxNumber: | 5738840943 | ||||||||
| Practice Location | |||||||||
| Address1: | 551 E SOUTHAMPTON DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652014236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738847733 | ||||||||
| FaxNumber: | 5738826228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 07/26/2019 | ||||||||
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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 | 207Q00000X | 52136-20 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2014015787 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0717751 | 05 | IA | MEDICAID | 758T5CR | 01 | MN | BCBS | OTHER | 34833600 | 05 | WI | MEDICAID | 773938900 | 05 | MN | MEDICAID | HP60848 | 01 | MN | HEALTHPARTNERS | OTHER | 1046258 | 01 | MN | PREFERRED ONE | OTHER | 66-09408 | 01 | MN | MEDICA CHOICE & PRIMARY | OTHER |