Healthcare Provider Details

I. General information

NPI: 1023032653
Provider Name (Legal Business Name): CHESTER L. CRUMP MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 HIGH ST SUITE 2D
HOPKINSVILLE KY
42240-6300
US

IV. Provider business mailing address

1717 HIGH ST SUITE 2D
HOPKINSVILLE KY
42240-6300
US

V. Phone/Fax

Practice location:
  • Phone: 270-885-6101
  • Fax: 270-885-3563
Mailing address:
  • Phone: 270-885-6101
  • Fax: 270-885-3563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHESTER L CRUMP
Title or Position: OWNER
Credential: MD
Phone: 270-885-6101