MR. CRAIG STEPHEN KANTACK PA-C NPI 1699052357

NPI Information

  • NPI: 1699052357
  • Provider Name: MR. CRAIG STEPHEN KANTACK, PA-C
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 740 S WOODRUFF AVE
    IDAHO FALLS, ID
    ZIP 83401
  • Phone: (208) 542-9111

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NPI Details

MR. Craig Stephen Kantack, PA-C is a medical physician assistant in Idaho Falls, ID with 14 years of experience. MR. Craig Stephen Kantack, PA-C NPI is 1699052357. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

740 S WOODRUFF AVE
IDAHO FALLS, ID
ZIP 83401-285
Phone: (208) 542-9111

The NPI 1699052357 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/9/2011 and was last updated on 4/12/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AM0700XPhysician AssistantMedicalPA-984IDAHOYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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