Provider Demographics
NPI:1639931967
Name:CROSSOVER HEALTH MEDICAL GROUP
Entity Type:Organization
Organization Name:CROSSOVER HEALTH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSING AND CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-500-2661
Mailing Address - Street 1:900 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-1243
Mailing Address - Country:US
Mailing Address - Phone:401-292-7777
Mailing Address - Fax:401-292-7778
Practice Address - Street 1:900 SALEM ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-1243
Practice Address - Country:US
Practice Address - Phone:401-292-7777
Practice Address - Fax:401-292-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty