Provider Demographics
NPI:1578848693
Name:CROSSWAY MEDICAL SERVICES
Entity Type:Organization
Organization Name:CROSSWAY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:D
Authorized Official - Last Name:HYDRICK
Authorized Official - Suffix:II
Authorized Official - Credentials:NP
Authorized Official - Phone:615-895-3600
Mailing Address - Street 1:2910 SOUTH CHURCH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-7149
Mailing Address - Country:US
Mailing Address - Phone:615-895-3600
Mailing Address - Fax:615-895-0024
Practice Address - Street 1:2910 SOUTH CHURCH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-7149
Practice Address - Country:US
Practice Address - Phone:615-895-3600
Practice Address - Fax:615-895-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WG0000X, 207QG0300X, 208D00000X
TN34250208D00000X
TN7765363LF0000X
TNAPN15544363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1891742904OtherNPI