Provider Demographics
NPI:1699778423
Name:CROSS, TRACY GLENN (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:GLENN
Last Name:CROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BURKESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602-1604
Mailing Address - Country:US
Mailing Address - Phone:606-387-3000
Mailing Address - Fax:606-387-3307
Practice Address - Street 1:250 BURKESVILLE RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:KY
Practice Address - Zip Code:42602-1604
Practice Address - Country:US
Practice Address - Phone:606-387-3000
Practice Address - Fax:606-387-3307
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33185208600000X, 174400000X, 207P00000X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64033525Medicaid
KY64033525Medicaid
KY1883501Medicare ID - Type Unspecified