MEDICARE: DR. TRACY GLENN CROSS M.D.

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	208600000X	Surgery Physician	33185	KY
2	174400000X	Specialist	33185	KY
3	207P00000X	Emergency Medicine Physician	33185	KY
4	207R00000X	Internal Medicine Physician	33185	KY
5	208M00000X	Hospitalist Physician	33185	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699778423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY GLENN CROSS M.D.

Provider Business Mailing Address
First Line	:	250 BURKESVILLE RD
Second Line	:
City	:	ALBANY
State	:	KY
Zip	:	42602-1604
Country	:	US
Telephone Number	:	606-387-3000
Fax Number	:	606-387-3307

Provider Business Practice Location Address
First Line	:	250 BURKESVILLE RD
Second Line	:
City	:	ALBANY
State	:	KY
Zip	:	42602-1604
Country	:	US
Telephone Number	:	606-387-3000
Fax Number	:	606-387-3307

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	12/21/2021

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