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1669479689

NPI Code Detail

MEDICARE: JAMES T CRIDER MD

MEDICARE: JAMES T CRIDER MD

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
1	207Q00000X	Family Medicine Physician	MD00035704	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	080128574	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8921236	OTHER	WA	CRIME VICTIMS
4	118361	OTHER	WA	LABOR & IND.
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669479689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES T CRIDER MD

Provider Business Mailing Address
First Line	:	PO BOX 3002
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-0302
Country	:	US
Telephone Number	:	360-747-5800
Fax Number	:	360-636-2336

Provider Business Practice Location Address
First Line	:	1718 E KESSLER BLVD
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-1842
Country	:	US
Telephone Number	:	360-747-5800
Fax Number	:	360-575-3846

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	06/27/2025

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Directions to “ JAMES T CRIDER MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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