Provider Demographics
NPI:1578684312
Name:MCCRAE MANAGEMENT & INVESTMENTS, LTD.
Entity type:Organization
Organization Name:MCCRAE MANAGEMENT & INVESTMENTS, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/CONTRACTING SPECIALIS
Authorized Official - Prefix:MS
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-858-0300
Mailing Address - Street 1:26222 RANCH ROAD 12
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4903
Mailing Address - Country:US
Mailing Address - Phone:512-858-0300
Mailing Address - Fax:512-858-2714
Practice Address - Street 1:3506 MAIN ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663
Practice Address - Country:US
Practice Address - Phone:360-260-2898
Practice Address - Fax:360-696-9517
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCCRAE MANAGEMENT & INVESTMENTS, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-02
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9178104Medicaid
243241700OtherOWCP
WA54627OtherWA LABOR & INDUSTRIES
OR212936Medicaid