Provider Demographics
NPI:1033135900
Name:CRAVENS MEDICAL CENTER, PLLC
Entity Type:Organization
Organization Name:CRAVENS MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:STUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-456-0881
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38557-0727
Mailing Address - Country:US
Mailing Address - Phone:931-456-0881
Mailing Address - Fax:931-456-1511
Practice Address - Street 1:189 LANTANA RD
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4902
Practice Address - Country:US
Practice Address - Phone:931-456-0881
Practice Address - Fax:931-456-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41045261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG48181Medicare UPIN
TN3734160Medicare ID - Type Unspecified