Provider Demographics
NPI:1376798918
Name:CRUM, PAUL MATTHEW (CRNA)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MATTHEW
Last Name:CRUM
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7818
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:4305 NEW SHEPHERDSVILLE RD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004
Practice Address - Country:US
Practice Address - Phone:502-350-5032
Practice Address - Fax:502-350-5022
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 274000163W00000X
KY3007686367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100232210-KOHMGMedicaid
KYP01977534-KOHMGOtherRR MEDICARE
IN300011007A-KOHMGMedicaid
KYK074154-KOHMGOtherKY MEDICARE