1790870137 NPI number — ANN W CRAIG MD

Table of content: ANN W CRAIG MD (NPI 1790870137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790870137 NPI number — ANN W CRAIG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAIG
Provider First Name:
ANN
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1790870137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 13TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-329-0204
Provider Business Mailing Address Fax Number:
606-324-7770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-329-0204
Provider Business Practice Location Address Fax Number:
606-324-7770
Provider Enumeration Date:
10/03/2006

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: 208000000X , with the licence number:  30254 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 65917544 . This is a "GROUP KY MEDICAID ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0110240000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000062597 . This is a "ANTHEM BC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 25721579 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 336109752062213 . This is a "BC SUPER BLUE PLUS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 6109752062213 . This is a "BC PPO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64302540 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12-03043 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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