Provider Demographics
NPI:1689186868
Name:CRANDALL MEDICAL
Entity type:Organization
Organization Name:CRANDALL MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:505-720-1877
Mailing Address - Street 1:PO BOX 21490
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87154-1490
Mailing Address - Country:US
Mailing Address - Phone:505-720-1877
Mailing Address - Fax:
Practice Address - Street 1:4924 WELLSBURG AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-3801
Practice Address - Country:US
Practice Address - Phone:505-720-1877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-28
Last Update Date:2017-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies