1588731533 NPI number — DR. WILLIAM B CRAFTON MD

Table of content: DR. WILLIAM B CRAFTON MD (NPI 1588731533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588731533 NPI number — DR. WILLIAM B CRAFTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAFTON
Provider First Name:
WILLIAM
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1588731533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
237 WILLIAM HOWARD TAFT, PHYS DIV
Provider Second Line Business Mailing Address:
2ND FL, CBO2-3, ATTN: CREDENTIALING
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-263-8571
Provider Business Mailing Address Fax Number:
513-366-4480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2123 AUBURN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45219-2906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-723-9000
Provider Business Practice Location Address Fax Number:
513-723-0455
Provider Enumeration Date:
11/28/2006

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: 208600000X , with the licence number:  35055281C , 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)

  • Identifier: 000000004576 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 200005445 . This is a "OHIO RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 31074182200 . This is a "OHIO WORKERS COMP GRP #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 64953052 . This is a "KENTUCKY MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200002530A . This is a "INDIANA MEDICAID INDIV #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200002500A . This is a "INDIANA MEDICAID GROUP #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 0673623 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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