Provider Demographics
NPI:1013173319
Name:CRAWFORD FAMILY MEDICINE, INC.
Entity Type:Organization
Organization Name:CRAWFORD FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-647-7411
Mailing Address - Street 1:33 DANIELSON PIKE
Mailing Address - Street 2:
Mailing Address - City:NORTH SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-1877
Mailing Address - Country:US
Mailing Address - Phone:410-647-7411
Mailing Address - Fax:401-647-2840
Practice Address - Street 1:33 DANIELSON PIKE
Practice Address - Street 2:
Practice Address - City:NORTH SCITUATE
Practice Address - State:RI
Practice Address - Zip Code:02857-1877
Practice Address - Country:US
Practice Address - Phone:410-647-7411
Practice Address - Fax:401-647-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07139261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9020220Medicaid
RID87110Medicare UPIN
RI089006553Medicare PIN