MEDICARE: CROSSWAY MEDICAL SERVICES

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	163WG0000X	General Practice Registered Nurse
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician
3	208D00000X	General Practice Physician
4	363LF0000X	Family Nurse Practitioner	7765	TN
5	363LF0000X	Family Nurse Practitioner	APN15544	TN
6	208D00000X	General Practice Physician	34250	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1891742904	OTHER	TN	NPI

General Provider Information

NPI Number	:	1578848693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSWAY MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	2910 SOUTH CHURCH STREET
Second Line	:	SUITE A
City	:	MURFREESBORO
State	:	TN
Zip	:	37127-7149
Country	:	US
Telephone Number	:	615-895-3600
Fax Number	:	615-895-0024

Provider Business Practice Location Address
First Line	:	2910 SOUTH CHURCH STREET
Second Line	:	SUITE A
City	:	MURFREESBORO
State	:	TN
Zip	:	37127-7149
Country	:	US
Telephone Number	:	615-895-3600
Fax Number	:	615-895-0024

Authorized Official
Title or Position	:	PROVIDER/OWNER
Name	:	JACK D HYDRICK II
Credential	:	NP
Telephone Number	:	615-895-3600

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	04/24/2013

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Directions to “CROSSWAY MEDICAL SERVICES ” Practice Location

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