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Individual

SCOTT WESLEY CRANICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
201 S 14TH ST, HERRIN, IL 62948-3631
(618) 942-2171
(618) 351-4917
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(800) 457-5200

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
085-002739
IL
363A00000X
Physician Assistant
Primary
085-002739
IL
363A00000X
Physician Assistant
PA9103859
FL
363AM0700X
Medical Physician Assistant
0010-00923
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
214881
MEDICARE OSCAR
IL
01
3932056
BLUE SHIELD
IL
Enumeration date
10/05/2006
Last updated
11/11/2020
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