Basic Information
| Provider Information | |||||||||
| NPI: | 1578566766 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARTIA | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | CLAYTON | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CARTIA | ||||||||
| OtherFirstName: | CRAIG | ||||||||
| OtherMiddleName: | C | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 73652 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441930002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593132758 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 106 BELINDA BLVD | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404223217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594390340 | ||||||||
| FaxNumber: | 8592094278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 11/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LA0401X | 32838 | KY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine |
ID Information
| ID | Type | State | Issuer | Description | 510I090003 | 01 | AL | MEDICARE AL | OTHER | 51610 | 01 | FL | BCBS FLORIDA | OTHER | 51541862 | 01 | AL | BCBS ALABAMA - BREW | OTHER | 59190259 | 01 | AL | BCBS ALABAMA | OTHER | 59190701 | 01 | AL | BCBS ALABAMA - GBO | OTHER | 59193342 | 01 | AL | BCBS ALABAMA - PACE | OTHER | B002 | 01 | FL | HEALTH FIRST | OTHER | 259910400 | 05 | FL | MEDICAID | 59193345 | 01 | AL | BCBS ALABAMA - PMR | OTHER | 1380902 | 01 | FL | UNITED HEALTHCARE | OTHER | P00397344 | 01 | FL | MEDICARE RAILROAD | OTHER |