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1689671406

NPI Code Detail

MEDICARE: KIMBERLY SUE CROSS MD

MEDICARE: KIMBERLY SUE CROSS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	19689	WV
2	208000000X	Pediatrics Physician	19689	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7354454	OTHER	WV	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	001721334	OTHER	WV	MS BCBS

General Provider Information

NPI Number	:	1689671406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY SUE CROSS MD

Provider Business Mailing Address
First Line	:	800 PENNSYLVANIA AVE
Second Line	:	CHILDREN'S MEDICINE CENTER
City	:	CHARLESTON
State	:	WV
Zip	:	25302
Country	:	US
Telephone Number	:	304-388-2525
Fax Number	:	304-388-2537

Provider Business Practice Location Address
First Line	:	800 PENNSYLVANIA AVE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25302-3351
Country	:	US
Telephone Number	:	304-388-2526
Fax Number	:	304-388-2537

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/05/2019

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Directions to “ KIMBERLY SUE CROSS MD” Practice Location

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