Provider Demographics
NPI:1407297963
Name:CROSSOVER HEALTH SERVICES INC
Entity Type:Organization
Organization Name:CROSSOVER HEALTH SERVICES INC
Other - Org Name:CROSSOVER COMMUNITY IMPACT, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARMIEN
Authorized Official - Middle Name:CHARNISETTE
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-398-9460
Mailing Address - Street 1:940 E 36TH ST N
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-1953
Mailing Address - Country:US
Mailing Address - Phone:918-398-9460
Mailing Address - Fax:918-398-9460
Practice Address - Street 1:940 E 36TH ST N
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-1953
Practice Address - Country:US
Practice Address - Phone:918-398-9460
Practice Address - Fax:918-398-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14202261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100089530CMedicaid
OK200514040AMedicaid