MEDICARE: CRAFT HOLDINGS LTD

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	261Q00000X	Clinic/Center	021145600	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285667444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAFT HOLDINGS LTD

Provider Business Mailing Address
First Line	:	PO BOX 126
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-0126
Country	:	US
Telephone Number	:	614-873-0880
Fax Number	:	614-873-0972

Provider Business Practice Location Address
First Line	:	480 S JEFFERSON AVE
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-4137
Country	:	US
Telephone Number	:	614-873-0880
Fax Number	:	614-873-0972

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. LONNIE JOE CRAFT
Credential	:	RPH
Telephone Number	:	614-573-1557

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	03/12/2020

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