Provider Demographics
NPI:1174663306
Name:RANDALL CRUM INC.
Entity Type:Organization
Organization Name:RANDALL CRUM INC.
Other - Org Name:THE SLEEP DISORDERS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-927-5141
Mailing Address - Street 1:11706 MERCY BLVD
Mailing Address - Street 2:BLDG. 4
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1751
Mailing Address - Country:US
Mailing Address - Phone:912-927-5141
Mailing Address - Fax:912-927-4441
Practice Address - Street 1:11706 MERCY BLVD
Practice Address - Street 2:BLDG. 4
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1751
Practice Address - Country:US
Practice Address - Phone:912-927-5141
Practice Address - Fax:912-927-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA47BBBMKMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER