Provider Demographics
NPI:1275675449
Name:NORRIS V CRUMP MD INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:NORRIS V CRUMP MD INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORRIS
Authorized Official - Middle Name:V
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:662-842-4427
Mailing Address - Street 1:PO BOX 1337
Mailing Address - Street 2:898 LYNDEN BLVD
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801
Mailing Address - Country:US
Mailing Address - Phone:662-842-4427
Mailing Address - Fax:662-840-1420
Practice Address - Street 1:898 LYNDEN BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801
Practice Address - Country:US
Practice Address - Phone:662-842-4427
Practice Address - Fax:662-840-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS8243207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00016859Medicaid
TN0122979OtherBCBS
AL73004335OtherBCBS
AL73004335OtherBCBS