MEDICARE: W. CRAIG TYREE, MD, PLC

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	174400000X	Specialist	34721	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000364525	OTHER	KY	ANTHEM GROUP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215126206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W. CRAIG TYREE, MD, PLC

Provider Business Mailing Address
First Line	:	PO BOX 416
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42142-0416
Country	:	US
Telephone Number	:	270-659-0184
Fax Number	:	270-651-9264

Provider Business Practice Location Address
First Line	:	103 TRISTA LN
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42141-3482
Country	:	US
Telephone Number	:	270-659-0184
Fax Number	:	270-651-9264

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	WILLIAM CRAIG TYREE
Credential	:	MD
Telephone Number	:	270-659-0184

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	11/12/2009

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