Provider Demographics
NPI:1477660967
Name:WILLIAM G. CRADDOCK
Entity Type:Organization
Organization Name:WILLIAM G. CRADDOCK
Other - Org Name:ADVANCED HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLINARD
Authorized Official - Suffix:
Authorized Official - Credentials:ATS, CRTS
Authorized Official - Phone:615-612-0087
Mailing Address - Street 1:104 GARNER AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2830
Mailing Address - Country:US
Mailing Address - Phone:615-612-0087
Mailing Address - Fax:615-612-0587
Practice Address - Street 1:104 GARNER AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2830
Practice Address - Country:US
Practice Address - Phone:615-612-0087
Practice Address - Fax:615-612-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000650332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2179198OtherAETNA HMO
TN3035094Medicaid
KY9027403600Medicaid
TN1452195Medicaid
TN55770104OtherAETNA
KY7100005360Medicaid
TN3035094OtherBLUE CROSS & BLUE SHIELD
TN3035094OtherBLUE CROSS & BLUE SHIELD
KY9027403600Medicaid