Basic Information
| Provider Information | |||||||||
| NPI: | 1659325785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRABTREE | ||||||||
| FirstName: | HERBERT | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9434 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658019434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178853888 | ||||||||
| FaxNumber: | 4178817638 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 S NATIONAL AVE | ||||||||
| Address2: | WEST TOWER, SUITE 700 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658075210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178853888 | ||||||||
| FaxNumber: | 4178817638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 09/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | C6588 | AR | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | R3K18 | MO | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2083264004 | 01 | MO | CIGNA HEALTHCARE | OTHER | 202835104 | 05 | MO | MEDICAID | 5M326 | 01 | AR | ARKANSAS BC/BS | OTHER | 02100025000 | 01 | MO | QUAL CHOICE | OTHER | 0215053 | 01 | WA | DEPARTMENT OF LABOR WA | OTHER | 18942 | 01 | MO | COX HEALTH PLANS | OTHER | 111023001 | 05 | AR | MEDICAID | 4188130001 | 01 | MO | CIGNA MEDICARE | OTHER | 5M326 | 01 | AR | ARKANSAS FIRST SOURCE | OTHER | C68084 | 01 | MO | USPS (W/C) | OTHER | 0640002 | 01 | MO | UNITED HEALTHCARE | OTHER | 8458 | 01 | MO | BLUE CROSS/CHOICE | OTHER | 188829 | 01 | MO | HEALTHLINK | OTHER | 5M326 | 01 | AR | HEALTH ADVANTAGE | OTHER | 1294 | 01 | MO | COX HEALTH PLANS UPI | OTHER |