MEDICARE: CRANIAL TECHNOLOGIES, INC.

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1891211942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRANIAL TECHNOLOGIES, INC.

Provider Business Mailing Address
First Line	:	1405 W AUTO DR FL 2
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-1016
Country	:	US
Telephone Number	:	480-403-6300
Fax Number	:	480-505-1842

Provider Business Practice Location Address
First Line	:	4244 RIVERWALK PKWY STE 180
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92505-8509
Country	:	US
Telephone Number	:	844-447-5894
Fax Number	:

Authorized Official
Title or Position	:	NATIONAL FACILITY DIRECTOR
Name	:	TAMMY JONES
Credential	:
Telephone Number	:	480-403-6330

Provider Enumeration Date	:	08/21/2017
Last Update Date	:	08/24/2021

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