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General NPI Number Information
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NPI Number | 1033135900
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Entity Type | Organization
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Legal Business Name | CRAVENS MEDICAL CENTER, PLLC
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 189 LANTANA RD
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City | CROSSVILLE
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State | TN
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Zip | 38555-4902
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Country | US
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Telephone | 931-456-0881
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Fax | 931-456-1511
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Provider Business Mailing Address
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Address Line | PO BOX 727
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City | CROSSVILLE
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State | TN
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Zip | 38557-0727
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Country | US
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Telephone | 931-456-0881
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Fax | 931-456-1511
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. BRIAN KEITH STUBBS
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Credential |
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Telephone | 931-456-0881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 41045
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License Number State | TN
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