| Devon Craft Do Pc | |
|
38 N Main St Ellenville NY 12428-1017 | |
| (845) 647-5430 | |
| Not Available |
| Full Name | Devon Craft Do Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 38 N Main St, Ellenville, New York |
| Authorized Official Name and Position | Devon Craft (OWNER/PHYSICIAN) |
| Authorized Official Contact | 8459011072 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Devon Craft Do Pc 38 N Main St Ellenville NY 12428-1017 Ph: () - | Devon Craft Do Pc 38 N Main St Ellenville NY 12428-1017 Ph: (845) 647-5430 |
| NPI Number | 1871052175 |
|---|---|
| Provider Enumeration Date | 03/16/2019 |
| Last Update Date | 03/16/2019 |
| Medicare PECOS PAC ID | 3577805563 |
|---|---|
| Medicare Enrollment ID | O20190423000746 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871052175 | NPI | - | NPPES |
| 05274704 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Devon Mark Craft |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831576412 PECOS PAC ID: 2961750286 Enrollment ID: I20180802002942 |
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