# W. CRAIG TYREE, MD, PLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215126206
- **Authorized official:** WILLIAM CRAIG TYREE MD (OWNER/MANAGER)
- **Authorized official phone:** (270) 659-0184

## Contact information

- **Practice address:** 103 TRISTA LN, GLASGOW, KY 42141-3482
- **Practice address phone:** (270) 659-0184
- **Practice address fax:** (270) 651-9264
- **Mailing address:** PO BOX 416, GLASGOW, KY 42142-0416
- **Mailing address phone:** (270) 659-0184
- **Mailing address fax:** (270) 651-9264

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 34721 | KY | Yes |

## Other

- **Enumeration date:** 10/16/2007
- **Last updated:** 11/12/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000364525 | ANTHEM GROUP NUMBER | KY |
| 05 | — | 64047186 | — | KY |