Healthcare Provider Details

I. General information

NPI: 1013173319
Provider Name (Legal Business Name): CRAWFORD FAMILY MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 DANIELSON PIKE
NORTH SCITUATE RI
02857-1877
US

IV. Provider business mailing address

33 DANIELSON PIKE
NORTH SCITUATE RI
02857-1877
US

V. Phone/Fax

Practice location:
  • Phone: 410-647-7411
  • Fax: 401-647-2840
Mailing address:
  • Phone: 410-647-7411
  • Fax: 401-647-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMD07139
License Number StateRI

VIII. Authorized Official

Name: DR. KIM JAY CRAWFORD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 401-647-7411