Provider Demographics
NPI:1346036571
Name:CROSSOVER HEALTH MEDICAL GROUP
Entity type:Organization
Organization Name:CROSSOVER HEALTH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. MANAGER LICENSING, CREDENTIALIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:971-500-2661
Mailing Address - Street 1:1515 S TRYON ST FL 9
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6816
Mailing Address - Country:US
Mailing Address - Phone:866-271-3589
Mailing Address - Fax:
Practice Address - Street 1:1515 S TRYON ST FL 9
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6816
Practice Address - Country:US
Practice Address - Phone:866-271-3589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
193200000XOtherNON MEDICARE