Provider Demographics
NPI:1063676302
Name:CRAIG GRONINGER
Entity Type:Organization
Organization Name:CRAIG GRONINGER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GRONINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-642-1851
Mailing Address - Street 1:2321 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46013-2762
Mailing Address - Country:US
Mailing Address - Phone:765-642-1851
Mailing Address - Fax:765-642-3756
Practice Address - Street 1:2321 CHARLES ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-2762
Practice Address - Country:US
Practice Address - Phone:765-642-1851
Practice Address - Fax:765-642-3756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN508420Medicare PIN
INU32500Medicare UPIN