Provider Demographics
NPI:1578501250
Name:W BOYD CRAFTON MD INC
Entity Type:Organization
Organization Name:W BOYD CRAFTON MD INC
Other - Org Name:DRS BOSSERT CRAFTON & NOVAK INC/ DRS BOSSERT & CRAFTON INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAFEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-723-9000
Mailing Address - Street 1:2123 AUBURN AVENUE
Mailing Address - Street 2:SUITE 242
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:513-723-9000
Mailing Address - Fax:513-723-0455
Practice Address - Street 1:2123 AUBURN AVENUE
Practice Address - Street 2:SUITE 242
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-723-9000
Practice Address - Fax:513-723-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055281C208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000004576OtherANTHEM
64953052OtherKENTUCKY MEDICAID
IN200002500AMedicaid
OH0052249Medicaid
IN200002530AMedicaid
OH0673623Medicaid
200005445OtherRR MEDICARE
IN200002500AMedicaid
OH0601551Medicare PIN
OH0673623Medicaid
A82777Medicare UPIN