Provider Demographics
NPI:1235310590
Name:J. STUART CRUTCHFIELD, M.D.,P.A.
Entity type:Organization
Organization Name:J. STUART CRUTCHFIELD, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:YOUNT
Authorized Official - Last Name:G
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-531-9901
Mailing Address - Street 1:722 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2001
Mailing Address - Country:US
Mailing Address - Phone:909-531-9901
Mailing Address - Fax:903-531-0079
Practice Address - Street 1:722 CLINIC DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2001
Practice Address - Country:US
Practice Address - Phone:909-531-9901
Practice Address - Fax:903-531-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNH6140174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty