Basic Information
| Provider Information | |||||||||
| NPI: | 1265570808 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRAWFORD | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | HOPKINS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 E GRAY ST | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025848002 | ||||||||
| FaxNumber: | 5025890849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2007 | ||||||||
| LastUpdateDate: | 02/15/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | 2008004916 | MO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XS0117X | R0688 | KY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XS0117X | TP699 | KY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XS0117X | 43066 | KY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 7100238200 | 05 | KY | MEDICAID | 109190 | 01 | NLSC/SIHO | OTHER | 200951090 | 05 | IN | MEDICAID | 3754853000 | 01 | NLSC/PAD | OTHER | 7157066 | 01 | NLSC/CIGNA | OTHER | 50026895 | 01 | NLSC/PHP | OTHER | 000000628568 | 01 | NLS/ANTHEM | OTHER | 000051983K | 01 | NLSC/HUMANA | OTHER |