1508823485 NPI number — DR. CHARLES C CRAIG M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508823485 NPI number — DR. CHARLES C CRAIG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAIG
Provider First Name:
CHARLES
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1508823485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 MEDICAL DRIVE
Provider Second Line Business Mailing Address:
SUITE 240
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67114-3765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-283-9977
Provider Business Mailing Address Fax Number:
316-283-0966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 MEDICAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-3765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-283-9977
Provider Business Practice Location Address Fax Number:
316-283-0966
Provider Enumeration Date:
04/26/2006

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: 207X00000X , with the licence number:  04-15116 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 668050 . This is a "FIRST HEALTH NETWORK" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 042441 . This is a "TRICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 200037434 . This is a "RR MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 4097036 . This is a "AETNA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 1318290001 . This is a "CIGNA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100086660G , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 198 . This is a "PREFERRED HEATH CARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com