Basic Information
| Provider Information | |||||||||
| NPI: | 1013969021 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUM | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 JACKSON PIKE | ||||||||
| Address2: | |||||||||
| City: | GALLIPOLIS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456311560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404465000 | ||||||||
| FaxNumber: | 7404465854 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 JACKSON PIKE | ||||||||
| Address2: | |||||||||
| City: | GALLIPOLIS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456311560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404465586 | ||||||||
| FaxNumber: | 7404465749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 03/14/2011 | ||||||||
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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 | 207P00000X | 34-00-5987 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 1629 | WV | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000006632 | 01 | ANTHEM BCBS | OTHER | 0048004000 | 05 | WV | MEDICAID | 000000185504 | 01 | UNISON MEDICAID | OTHER | 310917085153 | 01 | OH | OH MEDICAID CARESOURCE | OTHER | 001714100 | 01 | MOUNTAIN STATE BCBS | OTHER | 2035032 | 05 | OH | MEDICAID | 2035032 | 01 | OH | MOLINA MEDICAID | OTHER | 930054111 | 01 | RR MEDICARE | OTHER |