MEDICARE: KROSS INDUSTRIES

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	101Y00000X	Counselor	59846	FL

General Provider Information

NPI Number	:	1629562095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KROSS INDUSTRIES

Provider Business Mailing Address
First Line	:	6411 SANTA MONICA DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3347
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 SANTA MONICA DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3347
Country	:	US
Telephone Number	:	727-412-5196
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	SCOTTT EARNHARDT
Credential	:
Telephone Number	:	727-412-5196

Provider Enumeration Date	:	06/19/2018
Last Update Date	:	06/19/2018

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Directions to “KROSS INDUSTRIES ” Practice Location

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