Provider Demographics
NPI:1194253245
Name:CROFTON CLINIC PSC
Entity type:Organization
Organization Name:CROFTON CLINIC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANOJ
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJMUDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-220-0240
Mailing Address - Street 1:241 S MADISONVILLE ST
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:KY
Mailing Address - Zip Code:42217-8009
Mailing Address - Country:US
Mailing Address - Phone:270-220-0240
Mailing Address - Fax:
Practice Address - Street 1:241 S MADISONVILLE ST
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:KY
Practice Address - Zip Code:42217-8009
Practice Address - Country:US
Practice Address - Phone:270-220-0420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty