Basic Information
| Provider Information | |||||||||
| NPI: | 1801823877 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRASE | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 234 E. GRAY STREET | ||||||||
| Address2: | SUITE 850 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025851735 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 E. CHESTNUT STREET | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026297601 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 07/30/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD38755 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000000565638 | 01 | KY | ANTHEM BCBS | OTHER | 6412098300 | 05 | KY | MEDICAID | 30289901 | 05 | TN | MEDICAID | 4147357 | 01 | BCBS PROVIDER | OTHER | P00450596 | 01 | RAILROAD MEDICARE | OTHER |