Provider Demographics
NPI:1306066402
Name:JAMES B CRAVEN MD PA RHC
Entity type:Organization
Organization Name:JAMES B CRAVEN MD PA RHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:CRAVEN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:850-638-1230
Mailing Address - Street 1:PO BOX 800
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-0800
Mailing Address - Country:US
Mailing Address - Phone:850-638-1230
Mailing Address - Fax:850-638-9766
Practice Address - Street 1:1351 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-2220
Practice Address - Country:US
Practice Address - Phone:850-638-1230
Practice Address - Fax:850-638-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
103847Medicare ID - Type Unspecified