MEDICARE: CROSSCARE PLLC

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	111N00000X	Chiropractor		KY
2	208600000X	Surgery Physician	33185	KY
3	363LF0000X	Family Nurse Practitioner		KY
4	207Q00000X	Family Medicine Physician		KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K183220	OTHER	KY	MEDICATE GROUP PTAN

General Provider Information

NPI Number	:	1700297959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSCARE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 456
Second Line	:
City	:	ALBANY
State	:	KY
Zip	:	42602-0456
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	:	OWNER
Name	:	DR. TRACY G CROSS
Credential	:	MD
Telephone Number	:	606-387-3000

Provider Enumeration Date	:	05/09/2014
Last Update Date	:	10/28/2016

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