MEDICARE: HUGHIE CARLTON CRAINE III RPSGT

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	156F00000X	Technician/Technologist	15841

General Provider Information

NPI Number	:	1922754563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUGHIE CARLTON CRAINE III RPSGT

Provider Business Mailing Address
First Line	:	885 SW 6TH AVE
Second Line	:
City	:	WILLISTON
State	:	FL
Zip	:	32696-2419
Country	:	US
Telephone Number	:	478-919-1704
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 SW ARCHER RD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1135
Country	:	US
Telephone Number	:	352-376-1611
Fax Number	:

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

Provider Enumeration Date	:	02/22/2022
Last Update Date	:	02/22/2022

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