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NPI Code Detail

MEDICARE: CROSSOVER HEALTH MEDICAL GROUP

MEDICARE: CROSSOVER HEALTH MEDICAL GROUP
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
1174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1193200000XOTHEROTHER

General Provider Information

NPI Number : 1568250207
Entity Type Code : Organization
Provider Name (Legal Business Name) : CROSSOVER HEALTH MEDICAL GROUP
Provider Business Mailing Address
First Line : 12545 RIATA VISTA CIR
Second Line :
City : AUSTIN
State : TX
Zip : 78727-6524
Country : US
Telephone Number : 512-526-1776
Fax Number :
Provider Business Practice Location Address
First Line : 12545 RIATA VISTA CIR
Second Line :
City : AUSTIN
State : TX
Zip : 78727-6524
Country : US
Telephone Number : 512-526-1776
Fax Number :
Authorized Official
Title or Position : SR. MANAGER LICENSING & CREDENTIALI
Name : JENETTE HUNTER
Credential : CPCS
Telephone Number : 971-500-2661
Provider Enumeration Date : 04/30/2025
Last Update Date : 04/30/2025

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Directions to “CROSSOVER HEALTH MEDICAL GROUP ” Practice Location

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