Provider Demographics
NPI:1912970021
Name:CRUMBO, DONALD S (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:S
Last Name:CRUMBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 BELLE MEADE BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-3448
Mailing Address - Country:US
Mailing Address - Phone:615-889-1968
Mailing Address - Fax:
Practice Address - Street 1:5651 FRIST BLVD
Practice Address - Street 2:SUITE 603
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2054
Practice Address - Country:US
Practice Address - Phone:615-889-1968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13765207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64775778Medicaid
TN3705322Medicaid
TNP00684686OtherRR MEDICARE
TNA98220Medicare UPIN
TN30183811Medicare PIN
TN3705322Medicare ID - Type UnspecifiedMCR GROUP #