Provider Demographics
NPI:1649390584
Name:CRICK & FIFE, L.L.P.
Entity Type:Organization
Organization Name:CRICK & FIFE, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:CRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-827-3573
Mailing Address - Street 1:110 3RD ST STE 180
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-5808
Mailing Address - Country:US
Mailing Address - Phone:270-827-3573
Mailing Address - Fax:
Practice Address - Street 1:110 3RD ST STE 180
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-5808
Practice Address - Country:US
Practice Address - Phone:270-827-3573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-31
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20235208000000X
KY22605208000000X
KY35996208000000X
KY3094P208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64202351Medicaid
KY64020860Medicaid
KY65913394Medicaid
KY64226053Medicaid
KYC69303Medicare UPIN
KY64202351Medicaid
KYH28345Medicare UPIN
KY0209801Medicare ID - Type UnspecifiedLARRY CRICK MD
KY0209802Medicare ID - Type UnspecifiedKELLY FIFE MD