Provider Demographics
NPI:1891984696
Name:REAGAN CROSSNOE M.D P.A.
Entity Type:Organization
Organization Name:REAGAN CROSSNOE M.D P.A.
Other - Org Name:CROSSNOE ORTHOPEDIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:REAGAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CROSSNOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-547-0330
Mailing Address - Street 1:7120 SW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1704
Mailing Address - Country:US
Mailing Address - Phone:806-547-0330
Mailing Address - Fax:806-547-0331
Practice Address - Street 1:7120 SW 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1704
Practice Address - Country:US
Practice Address - Phone:806-547-0330
Practice Address - Fax:806-547-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9511302F00000X
207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00783UMedicare PIN