Provider Demographics
NPI:1811941040
Name:SUSAN K CRAIG M D P A
Entity type:Organization
Organization Name:SUSAN K CRAIG M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:409-835-2300
Mailing Address - Street 1:3070 COLLEGE STREET
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4688
Mailing Address - Country:US
Mailing Address - Phone:409-835-2300
Mailing Address - Fax:409-835-2375
Practice Address - Street 1:3070 COLLEGE STREET
Practice Address - Street 2:SUITE 120
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4688
Practice Address - Country:US
Practice Address - Phone:409-835-2300
Practice Address - Fax:409-835-2375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2884207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213984201Medicaid
TX0002QNOtherBCBS PROVIDER NUMBER
TX213984201Medicaid
TX0002QNOtherBCBS PROVIDER NUMBER
TXG72035Medicare UPIN