Provider Demographics
NPI:1568792778
Name:CRIMSON DIAGNOSTICS
Entity Type:Organization
Organization Name:CRIMSON DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICCI
Authorized Official - Middle Name:
Authorized Official - Last Name:KEAHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-726-3413
Mailing Address - Street 1:2932 ROSS CLARK CIR STE 320
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1160
Mailing Address - Country:US
Mailing Address - Phone:334-726-3413
Mailing Address - Fax:
Practice Address - Street 1:126 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-2018
Practice Address - Country:US
Practice Address - Phone:334-726-3413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service