Provider Demographics
NPI:1306809215
Name:CRIGGER AND ASSOCIATES ENT PLLC
Entity type:Organization
Organization Name:CRIGGER AND ASSOCIATES ENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRIGGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-767-7980
Mailing Address - Street 1:PO BOX 9289
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-0289
Mailing Address - Country:US
Mailing Address - Phone:304-767-7980
Mailing Address - Fax:304-767-7989
Practice Address - Street 1:4607 MACCORKLE AVE SW
Practice Address - Street 2:STE 406
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1364
Practice Address - Country:US
Practice Address - Phone:304-767-7980
Practice Address - Fax:304-767-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004058Medicaid
WVCR9342901Medicare ID - Type Unspecified