Provider Demographics
NPI:1578688164
Name:CRANIAL TECHNOLOGIES, INC.
Entity Type:Organization
Organization Name:CRANIAL TECHNOLOGIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS RESOURCES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-403-6330
Mailing Address - Street 1:1405 W AUTO DR FL 2
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1016
Mailing Address - Country:US
Mailing Address - Phone:480-403-6300
Mailing Address - Fax:480-505-1842
Practice Address - Street 1:1111 W 34TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1900
Practice Address - Country:US
Practice Address - Phone:512-374-0089
Practice Address - Fax:512-374-0751
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRANIAL TECHNOLOGIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-20
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009929302Medicaid