Basic Information
| Provider Information | |||||||||
| NPI: | 1235301508 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICHARD H. CROUCH, M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 S 8TH ST STE 301E | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420712403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707594099 | ||||||||
| FaxNumber: | 2707673626 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 S 8TH ST STE 301E | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420712403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707594099 | ||||||||
| FaxNumber: | 2707673626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2008 | ||||||||
| LastUpdateDate: | 03/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | PAGE | ||||||||
| AuthorizedOfficialFirstName: | CAROLYN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2707594099 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | CMA (AAMA) | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 19518 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8463 | 01 | KY | MEDICARE GROUP NUMBER | OTHER | 64195183 | 05 | KY | MEDICAID | 78903705 | 01 | KY | MEDICAID NURSE PRACTITION | OTHER |