1780934893 NPI number — RANDALL CRUM INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780934893 NPI number — RANDALL CRUM INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANDALL CRUM INC.
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:
POOLER SLEEP DISORDER CENTER
Provider Other Organization Name Type Code:
3
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:
1780934893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 CANAL ST
Provider Second Line Business Mailing Address:
STE. 601
Provider Business Mailing Address City Name:
POOLER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31322-4085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-330-0979
Provider Business Mailing Address Fax Number:
912-330-3710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 CANAL ST
Provider Second Line Business Practice Location Address:
STE. 601
Provider Business Practice Location Address City Name:
POOLER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31322-4085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-330-0979
Provider Business Practice Location Address Fax Number:
912-330-0739
Provider Enumeration Date:
09/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CRUM
Authorized Official First Name:
RANDALL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
912-297-5141

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com