Provider Demographics
NPI:1235301508
Name:RICHARD H. CROUCH, M.D.
Entity Type:Organization
Organization Name:RICHARD H. CROUCH, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:CMA (AAMA)
Authorized Official - Phone:270-759-4099
Mailing Address - Street 1:300 S 8TH ST STE 301E
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2403
Mailing Address - Country:US
Mailing Address - Phone:270-759-4099
Mailing Address - Fax:270-767-3626
Practice Address - Street 1:300 S 8TH ST STE 301E
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2403
Practice Address - Country:US
Practice Address - Phone:270-759-4099
Practice Address - Fax:270-767-3626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8463OtherMEDICARE GROUP NUMBER
KY64195183Medicaid
KY78903705OtherMEDICAID NURSE PRACTITION