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NPI Code Detail

MEDICARE: CRISSMAN FAMILY PRACTICE

MEDICARE: CRISSMAN FAMILY PRACTICE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295772721
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRISSMAN FAMILY PRACTICE
Provider Business Mailing Address
First Line : 214 E ELM ST
Second Line :
City : GRAHAM
State : NC
Zip : 27253-3022
Country : US
Telephone Number : 336-226-2448
Fax Number : 336-226-5894
Provider Business Practice Location Address
First Line : 214 E ELM ST
Second Line :
City : GRAHAM
State : NC
Zip : 27253-3022
Country : US
Telephone Number : 336-226-2448
Fax Number : 336-226-5894
Authorized Official
Title or Position : PRESIDENT
Name : DR. MARK ANDERS CRISSMAN
Credential : M.D.
Telephone Number : 336-226-2448
Provider Enumeration Date : 06/01/2006
Last Update Date : 08/22/2020

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Directions to “CRISSMAN FAMILY PRACTICE ” Practice Location

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