Provider Demographics
NPI:1942740741
Name:CROSSINGS CLINIC LOUISVILLE PLLC
Entity Type:Organization
Organization Name:CROSSINGS CLINIC LOUISVILLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-949-2338
Mailing Address - Street 1:5104 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9429
Mailing Address - Country:US
Mailing Address - Phone:812-949-2338
Mailing Address - Fax:
Practice Address - Street 1:3935 DUPONT CIR
Practice Address - Street 2:SUITE C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4824
Practice Address - Country:US
Practice Address - Phone:502-458-7476
Practice Address - Fax:502-458-7797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty