MEDICARE: DR. CREIGHTON B WRIGHT SR. MD, MBA

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	21791	KY
2	208600000X	Surgery Physician	21791	KY
3	2086S0129X	Vascular Surgery Physician	21791	KY
4	208600000X	Surgery Physician	35046888W	OH
5	2086S0129X	Vascular Surgery Physician	35046888W	OH
6	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	35046888W	OH
7	174400000X	Specialist	21791	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000000005036	OTHER	ANTHEM
2	1820074	OTHER	UNITEDHEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	46888	OTHER	CHOICE CARE/HUMANA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	8330	OTHER	KY BCBS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275525560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CREIGHTON B WRIGHT SR. MD, MBA

Provider Business Mailing Address
First Line	:	3300 MERCY HEALTH BLVD
Second Line	:	5TH FLOOR
City	:	CINCINNATI
State	:	OH
Zip	:	45211-1103
Country	:	US
Telephone Number	:	513-215-5030
Fax Number	:	513-215-5954

Provider Business Practice Location Address
First Line	:	3300 MERCY HEALTH BLVD
Second Line	:	5TH FLOOR
City	:	CINCINNATI
State	:	OH
Zip	:	45211-1103
Country	:	US
Telephone Number	:	513-215-5030
Fax Number	:	513-215-5954

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	01/30/2017

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