Healthcare Provider Details

I. General information

NPI: 1700297959
Provider Name (Legal Business Name): CROSSCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BURKESVILLE RD
ALBANY KY
42602-1604
US

IV. Provider business mailing address

PO BOX 456
ALBANY KY
42602-0456
US

V. Phone/Fax

Practice location:
  • Phone: 606-387-3000
  • Fax: 606-387-3307
Mailing address:
  • Phone: 606-387-3000
  • Fax: 606-387-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number33185
License Number StateKY

VIII. Authorized Official

Name: DR. TRACY G CROSS
Title or Position: OWNER
Credential: MD
Phone: 606-387-3000