Active NPI
Craig Thurber
- Athletic Trainer
- Fort Wayne, IN
National Provider Identifier
1407358674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 36002835A
- Practice address
- 3946 Ice Way
Fort Wayne, IN 46808 - Phone
- (785) 305-0555
- NPI assigned
- Mar 5, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT005515 | OH | |
| Athletic Trainer | 2255A2300X | 36002835A | IN | Primary |
Addresses
Primary practice location
3946 Ice Way
Fort Wayne, IN 46808
Mailing address
3946 Ice Way
Fort Wayne, IN 46808
Other practice location 1
1600 E Washington Blvd
Fort Wayne, IN 46803
Phone (785) 305-0555
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36002835A | IN | MD | Athletic Trainer |
| AT005515 | OH | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1407358674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3946 ICE WAY",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "46808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3946 ICE WAY",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "46808",
"telephone_number": "785-305-0555"
}
],
"practiceLocations": [
{
"address_1": "1600 E Washington Blvd",
"address_purpose": "LOCATION",
"city": "Fort Wayne",
"state": "IN",
"postal_code": "46803",
"country_code": "US",
"telephone_number": "785-305-0555",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "THURBER",
"first_name": "CRAIG",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-03-05",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OH",
"license": "AT005515",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36002835A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.