1689699837 NPI number — CRAIG RESOURCES LLC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689699837 NPI number — CRAIG RESOURCES LLC

Employer Identification Number (EIN):

Provider Organization Name:

CRAIG RESOURCES LLC

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

Provider Other Organization Name Type Code:

6

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:

1689699837

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

03/13/2025

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1220 E 1ST ST N

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WICHITA

Provider Business Mailing Address State Name:

KS

Provider Business Mailing Address Postal Code:

67214-3907

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

316-266-8717

Provider Business Mailing Address Fax Number:

316-266-8757

Provider First Line Business Practice Location Address:

1220 E 1ST ST N

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WICHITA

Provider Business Practice Location Address State Name:

KS

Provider Business Practice Location Address Postal Code:

67214-3907

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

316-264-9988

Provider Business Practice Location Address Fax Number:

316-264-0016

Provider Enumeration Date:

07/12/2006

Authorized Official Last Name:

BULMAN

Authorized Official First Name:

JOYCE

Authorized Official Middle Name:

A

Authorized Official Title or Position:

VP OF QUALITY & COM PLIANCE

Authorized Official Telephone Number:

651-789-0926

• Taxonomy code: 251E00000X , with the licence number:  A-085-010 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 251E00000X , with the licence number: A-068-002 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 251E00000X , with the licence number: A-089-031 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 251E00000X , with the licence number: A-050-007 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 251E00000X , with the licence number: HHA200609 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 385H00000X , with the licence number: A-089-031 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 385H00000X , with the licence number: A-050-007 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 385H00000X , with the licence number: A-087-046 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 385H00000X , with the licence number: A-085-010 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 385H00000X , with the licence number: A-068-002 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 100066570C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 30003931500011 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 945429900 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
• Identifier: 100007090E , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 100066570F , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 10025453800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 100007090A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 30003931500027 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 100007090C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 100007090F , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 10026433800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 30003931500004 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 30003931500006 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 30003931500007 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".