Provider Demographics
NPI:1457661662
Name:DAVID G. CRANE, INC.
Entity Type:Organization
Organization Name:DAVID G. CRANE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-339-1221
Mailing Address - Street 1:802 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-4644
Mailing Address - Country:US
Mailing Address - Phone:812-339-1221
Mailing Address - Fax:
Practice Address - Street 1:802 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-4644
Practice Address - Country:US
Practice Address - Phone:812-339-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01019739302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization