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General NPI Number Information
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NPI Number | 1629931886
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Entity Type | Organization
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Legal Business Name | CROSSOVER HEALTH MEDICAL GROUP
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 9350 S 150 E STE 101
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City | SANDY
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State | UT
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Zip | 84070-2702
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Country | US
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Telephone | 971-500-2661
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Fax |
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Provider Business Mailing Address
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Address Line | 9350 S 150 E STE 101
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City | SANDY
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State | UT
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Zip | 84070-2702
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Country | US
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Telephone | 971-500-2661
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Fax |
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Authorized Official
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Title or Position | SR. MANAGER OF CREDENTIALING
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Name | MRS. JENETTE HUNTER
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Credential | CPCS
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Telephone | 971-500-2661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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