MEDICARE: CRIBCRAFTERS

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	332BC3200X	Customized Equipment (DME)	2705109387	VA

General Provider Information

NPI Number	:	1043407240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRIBCRAFTERS

Provider Business Mailing Address
First Line	:	2206 CASTLE ROCK SQ APT 22C
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-2206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2206 CASTLE ROCK SQ APT 22C
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-2206
Country	:	US
Telephone Number	:	703-338-0822
Fax Number	:	703-880-7058

Authorized Official
Title or Position	:	OWNER
Name	:	BRAD MEYER
Credential	:
Telephone Number	:	703-338-0822

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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Directions to “CRIBCRAFTERS ” Practice Location

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