Healthcare Provider Details

I. General information

NPI: 1578848693
Provider Name (Legal Business Name): CROSSWAY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 SOUTH CHURCH STREET SUITE A
MURFREESBORO TN
37127-7149
US

IV. Provider business mailing address

2910 SOUTH CHURCH STREET SUITE A
MURFREESBORO TN
37127-7149
US

V. Phone/Fax

Practice location:
  • Phone: 615-895-3600
  • Fax: 615-895-0024
Mailing address:
  • Phone: 615-895-3600
  • Fax: 615-895-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7765
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN15544
License Number StateTN
# 6
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number34250
License Number StateTN

VIII. Authorized Official

Name: JACK D HYDRICK II
Title or Position: PROVIDER/OWNER
Credential: NP
Phone: 615-895-3600