Healthcare Provider Details

I. General information

NPI: 1578794863
Provider Name (Legal Business Name): CITY OF CRAIG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 3RD ST.
CRAIG AK
99921
US

IV. Provider business mailing address

PO BOX 656
CRAIG AK
99921-0656
US

V. Phone/Fax

Practice location:
  • Phone: 907-826-3257
  • Fax: 907-826-3259
Mailing address:
  • Phone: 907-826-3257
  • Fax: 907-826-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number710680
License Number StateAK

VIII. Authorized Official

Name: ROBERT C THOMAS
Title or Position: ADMINISTRATOR
Credential: M.D.
Phone: 907-826-3257