Provider Demographics
NPI:1558731067
Name:CRIMSON INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:CRIMSON INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:TACTUK ROMANENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-349-1606
Mailing Address - Street 1:1015 RICE VALLEY RD N
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2782
Mailing Address - Country:US
Mailing Address - Phone:205-349-1606
Mailing Address - Fax:205-349-3263
Practice Address - Street 1:1015 RICE VALLEY RD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406
Practice Address - Country:US
Practice Address - Phone:205-349-1606
Practice Address - Fax:205-349-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty