1508108572 NPI number — LAUREN N CRAIG PC

Table of content: LAUREN N CRAIG PC (NPI 1508108572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508108572 NPI number — LAUREN N CRAIG PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAIG
Provider First Name:
LAUREN
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508108572
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 S EDWIN C MOSES BLVD
Provider Second Line Business Mailing Address:
1ST FLOOR, NW BLDG
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45417-3424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-224-4646
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 S EDWIN C MOSES BLVD
Provider Second Line Business Practice Location Address:
1ST FLOOR, NW BLDG
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45417-3424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-224-4646
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/18/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  090253 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: C.1100222 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)