Provider Demographics
NPI:1295808178
Name:CRAWFORD RADIOLOGY LTD
Entity type:Organization
Organization Name:CRAWFORD RADIOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KNUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-544-3131
Mailing Address - Street 1:PO BOX 790126
Mailing Address - Street 2:DEPT 30660
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0126
Mailing Address - Country:US
Mailing Address - Phone:866-331-7699
Mailing Address - Fax:
Practice Address - Street 1:1000 N ALLEN ST
Practice Address - Street 2:DEPT OF RADIOLOGY
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454
Practice Address - Country:US
Practice Address - Phone:616-544-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001732008OtherBCBS OF ILL
IL0001732008OtherBCBS OF ILL