Basic Information
| Provider Information | |||||||||
| NPI: | 1548664519 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLEN CRAIG AU D INC | ||||||||
| LastName: | |||||||||
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| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ASCENT AUDIOLOGY & HEARING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 820 E MATTHEWS AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724013048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702681488 | ||||||||
| FaxNumber: | 8702681613 | ||||||||
| Practice Location | |||||||||
| Address1: | 820 E MATTHEWS AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724013048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702681488 | ||||||||
| FaxNumber: | 8702681613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2014 | ||||||||
| LastUpdateDate: | 10/20/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CRAIG | ||||||||
| AuthorizedOfficialFirstName: | SAMUEL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 8702681488 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | AU D | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0700X | A189 | AR | Y | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech |
No ID Information.