Provider Demographics
NPI:1841369808
Name:CREWE MEDICAL CENTER
Entity type:Organization
Organization Name:CREWE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-645-9191
Mailing Address - Street 1:P.O. BOX 528
Mailing Address - Street 2:12522 W. COLONIAL TRAIL HWY.
Mailing Address - City:CREWE
Mailing Address - State:VA
Mailing Address - Zip Code:23930
Mailing Address - Country:US
Mailing Address - Phone:434-645-9191
Mailing Address - Fax:434-645-1859
Practice Address - Street 1:12522 W. COLONIAL TRAIL HWY.
Practice Address - Street 2:
Practice Address - City:CREWE
Practice Address - State:VA
Practice Address - Zip Code:23930
Practice Address - Country:US
Practice Address - Phone:434-645-9191
Practice Address - Fax:434-645-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5619645Medicaid
VA5630185Medicaid
VAH38433Medicare UPIN
VA5630185Medicaid
VA080007760Medicare ID - Type UnspecifiedCLARENCE E HALL II, MD
VA5619645Medicaid