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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