Provider Demographics
NPI:1235384744
Name:CRAIG E. MEYER, M.D., F.A.C.S.
Entity Type:Organization
Organization Name:CRAIG E. MEYER, M.D., F.A.C.S.
Other - Org Name:EAR, NOSE, AND THROAT, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-389-9696
Mailing Address - Street 1:500 ARCADE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2477
Mailing Address - Country:US
Mailing Address - Phone:574-389-9696
Mailing Address - Fax:574-389-9797
Practice Address - Street 1:500 ARCADE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2477
Practice Address - Country:US
Practice Address - Phone:574-389-9696
Practice Address - Fax:574-389-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031695A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100112550BMedicaid
IN100112550BMedicaid