Provider Demographics
NPI:1972689412
Name:CRITERION MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CRITERION MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-608-9491
Mailing Address - Street 1:3632 E SOUTH FORK DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6614
Mailing Address - Country:US
Mailing Address - Phone:800-608-9491
Mailing Address - Fax:480-706-6582
Practice Address - Street 1:3632 E SOUTH FORK DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6614
Practice Address - Country:US
Practice Address - Phone:800-608-9491
Practice Address - Fax:480-706-6582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
D4317790001OtherUNITED AMERICAN INSURANCE
WI41730200Medicaid
D4317790001OtherUNITED AMERICAN INSURANCE
=========OtherCIGNA HEALTH CARE
=========OtherHUMANA GOLD
=========OtherMUTUAL OF OMAHA
WI41730200Medicaid
IL=========OtherBLUE CROSS/BLUE SHIELD
=========OtherAMERICAN GENERAL LIFE&ACC
IL=========001Medicaid
=========OtherUNI CARE
=========OtherWAUSAU BENEFITS INC.
=========OtherAARP
MI=========OtherBLUE CROSS/BLUE SHIELD
=========OtherMAILHANDLERS BENEFIT PLAN
=========OtherUNITED HEALTH CARE
=========OtherCHRISTIANFIDELITY
=========OtherAETNA
IL=========001Medicaid