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1922071448

NPI Code Detail

MEDICARE: DR. MARISSA GALVEZ VITO CRUZ MD

MEDICARE: DR. MARISSA GALVEZ VITO CRUZ 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	207P00000X	Emergency Medicine Physician	0101221333	VA
2	207Q00000X	Family Medicine Physician	48344	TN
3	207Q00000X	Family Medicine Physician	0101221333	VA
4	208M00000X	Hospitalist Physician	48344	TN
5	208M00000X	Hospitalist Physician	0101221333	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01245198	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922071448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARISSA GALVEZ VITO CRUZ MD

Provider Business Mailing Address
First Line	:	1021 W OAKLAND AVE STE 310
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2192
Country	:	US
Telephone Number	:	423-302-6567
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 15TH ST NW
Second Line	:
City	:	NORTON
State	:	VA
Zip	:	24273-1616
Country	:	US
Telephone Number	:	276-679-9002
Fax Number	:	276-679-9078

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	07/15/2024

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Directions to “ DR. MARISSA GALVEZ VITO CRUZ MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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