Basic Information
| Provider Information | |||||||||
| NPI: | 1497006720 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RANDALL CRUM INC. | ||||||||
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| OtherOrganizationName: | THE SLEEP DISORDERS CENTER AT FT. STEWART GEORGIA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 VETERANS PARKWAY | ||||||||
| Address2: | SUITE 112 A-2 | ||||||||
| City: | HINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123683709 | ||||||||
| FaxNumber: | 9123683710 | ||||||||
| Practice Location | |||||||||
| Address1: | 790 VETERANS PKWY | ||||||||
| Address2: | SUITE 112 A-2 | ||||||||
| City: | HINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313133915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123683709 | ||||||||
| FaxNumber: | 9123683710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2012 | ||||||||
| LastUpdateDate: | 09/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | CRUM | ||||||||
| AuthorizedOfficialFirstName: | RANDALL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9129275141 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RANDALL CRUM, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.