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Organization
WILLIAM G. CRADDOCK
Active
Organization
WILLIAM G. CRADDOCK
Active
Other names
Advanced Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETE L. CLINARD ATS, CRTS (MANAGER)
(615) 612-0087
Entity
Organization
Contact information
Practice address
104 GARNER AVE, MADISON, TN 37115-2830
(615) 612-0087
(615) 612-0587
Mailing address
104 GARNER AVE, MADISON, TN 37115-2830
(615) 612-0087
(615) 612-0587
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0000000650
TN
332BC3200X
Customized Equipment (DME)
Primary
0000000650
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1452195
—
TN
01
—
2179198
AETNA HMO
TN
01
—
3035094
BLUE CROSS & BLUE SHIELD
TN
05
—
3035094
—
TN
01
—
55770104
AETNA
TN
05
—
7100005360
—
KY
05
—
9027403600
—
KY
Enumeration date
08/23/2006
Last updated
01/24/2012
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