1275675449 NPI number — NORRIS V CRUMP MD INTERNAL MEDICINE PA

Table of content: CHERIE BREWER MSN, APRN (PENDING) (NPI 1780559195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275675449 NPI number — NORRIS V CRUMP MD INTERNAL MEDICINE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORRIS V CRUMP MD INTERNAL MEDICINE PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275675449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1337
Provider Second Line Business Mailing Address:
898 LYNDEN BLVD
Provider Business Mailing Address City Name:
TUPELO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-842-4427
Provider Business Mailing Address Fax Number:
662-840-1420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
898 LYNDEN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUPELO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-842-4427
Provider Business Practice Location Address Fax Number:
662-840-1420
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CRUMP
Authorized Official First Name:
NORRIS
Authorized Official Middle Name:
V
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
662-842-4427

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  8243 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00016859 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0122979 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 73004335 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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