Healthcare Provider Details

I. General information

NPI: 1609875194
Provider Name (Legal Business Name): CRAIG A FOSS AU.D F-AAA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 WEST FAIDLEY AVENUE
GRAND ISLAND NE
68803-4328
US

IV. Provider business mailing address

2421 WEST FAIDLEY AVENUE
GRAND ISLAND NE
68803-4328
US

V. Phone/Fax

Practice location:
  • Phone: 308-384-2101
  • Fax: 308-381-4787
Mailing address:
  • Phone: 308-384-2101
  • Fax: 308-381-4787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number64
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number64&020
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number020
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: