Provider Demographics
NPI:1346821873
Name:CROSS, MARK ANTHONY
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:CROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 TARPLEY RD
Mailing Address - Street 2:
Mailing Address - City:POLLOCK
Mailing Address - State:LA
Mailing Address - Zip Code:71467-4502
Mailing Address - Country:US
Mailing Address - Phone:318-664-2627
Mailing Address - Fax:
Practice Address - Street 1:168 TARPLEY RD
Practice Address - Street 2:
Practice Address - City:POLLOCK
Practice Address - State:LA
Practice Address - Zip Code:71467-4502
Practice Address - Country:US
Practice Address - Phone:318-664-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA004712653343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)