Provider Demographics
NPI:1063510386
Name:CRIGHTON OLIVE DUNN SURGICAL GROUP INC
Entity Type:Organization
Organization Name:CRIGHTON OLIVE DUNN SURGICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-882-2349
Mailing Address - Street 1:1230 E KINGSLEY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7211
Mailing Address - Country:US
Mailing Address - Phone:417-882-2349
Mailing Address - Fax:417-882-1083
Practice Address - Street 1:1230 E KINGSLEY ST
Practice Address - Street 2:SUITE C
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7211
Practice Address - Country:US
Practice Address - Phone:417-882-2349
Practice Address - Fax:417-882-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO14681Medicare ID - Type Unspecified