Organization
CRAIG K. MATHESON, D.O., P.L.L.C.
Active
Other names
Third Coast Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CRAIG KENNETH MATHESON D.O. (OWNER AND SOLE MEMBER)
(231) 757-2500
Entity
Organization
Contact information
Practice address
821 W US HIGHWAY 10 31, SCOTTVILLE, MI 49454-9601
(231) 757-2500
(231) 757-9073
Mailing address
821 WEST U.S. HIGHWAY 10, SCOTTVILLE, MI 49454
(231) 757-2500
(231) 757-9073
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
5101011416
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0855301234
BLUE CROSS BLUE SHIELD ID
MI
05
—
4615194
—
MI
01
—
CLIA
23D1038209
MI
Enumeration date
02/23/2007
Last updated
02/17/2021
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