Provider Demographics
NPI:1427184563
Name:CROSS, JAMES M (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:CROSS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5025
Mailing Address - Country:US
Mailing Address - Phone:325-692-9119
Mailing Address - Fax:325-692-6030
Practice Address - Street 1:2120 ANTILLEY RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5211
Practice Address - Country:US
Practice Address - Phone:325-695-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36560367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C37MOtherBLUE CROSS
TX088873703Medicaid
TX088873703Medicaid