Provider Demographics
NPI:1609875194
Name:FOSS, CRAIG A (AUD F-AAA)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:FOSS
Suffix:
Gender:M
Credentials:AUD F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 WEST FAIDLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4328
Mailing Address - Country:US
Mailing Address - Phone:308-384-2101
Mailing Address - Fax:308-381-4787
Practice Address - Street 1:2421 WEST FAIDLEY AVENUE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4328
Practice Address - Country:US
Practice Address - Phone:308-384-2101
Practice Address - Fax:308-381-4787
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE020237600000X
NE64231H00000X
NE64&020237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47073801200Medicaid
NE10025275800Medicaid
NE086319OtherMEDICARE GROUP
NER29857Medicare UPIN
NE990013150Medicare PIN
NE47073801200Medicaid