Provider Demographics
NPI:1629638481
Name:CROSSOVER HEALTH MEDICAL GROUP
Entity Type:Organization
Organization Name:CROSSOVER HEALTH MEDICAL GROUP
Other - Org Name:CROSSOVER HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HR OPERATIONS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKIOKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-891-0328
Mailing Address - Street 1:1701 JOHN F KENNEDY BLVD FL 25
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-2851
Mailing Address - Country:US
Mailing Address - Phone:949-891-0328
Mailing Address - Fax:
Practice Address - Street 1:1701 JOHN F KENNEDY BLVD FL 25
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-2851
Practice Address - Country:US
Practice Address - Phone:949-891-0328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-14
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty