Healthcare Provider Details

I. General information

NPI: 1699896506
Provider Name (Legal Business Name): MCCRAE MANAGEMENT & INVESTMENTS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 NW EASTMAN PARKWAY
GRESHAM OR
97030-7203
US

IV. Provider business mailing address

26222 RANCH ROAD 12
DRIPPING SPRINGS TX
78620-4903
US

V. Phone/Fax

Practice location:
  • Phone: 503-667-3832
  • Fax: 503-667-3103
Mailing address:
  • Phone: 512-858-0300
  • Fax: 512-858-2714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: MS. ELISE DOMINEY
Title or Position: CREDENTIALING/CONTRACTING SPECIALIS
Credential:
Phone: 512-858-0300