Provider Demographics
NPI:1033161211
Name:ROBERT G CRUMMIE
Entity Type:Organization
Organization Name:ROBERT G CRUMMIE
Other - Org Name:THE RAINTREE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:G
Authorized Official - Last Name:CRUMMIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-287-8861
Mailing Address - Street 1:236 CHARLOTTE RD
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-2914
Mailing Address - Country:US
Mailing Address - Phone:828-287-8861
Mailing Address - Fax:828-287-8862
Practice Address - Street 1:236 CHARLOTTE RD
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2914
Practice Address - Country:US
Practice Address - Phone:828-287-8861
Practice Address - Fax:828-287-8862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
26275OtherBCBS
NC8926275Medicaid
NC8926275Medicaid