1336146927 NPI number — JONATHAN S CROSS MD

Table of content: JONATHAN S CROSS MD (NPI 1336146927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336146927 NPI number — JONATHAN S CROSS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROSS
Provider First Name:
JONATHAN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336146927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9960 NW 116TH WAY STE 13
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDLEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33178-1175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-924-1311
Provider Business Mailing Address Fax Number:
786-924-1313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21000 NE 28TH AVE STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVENTURA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33180-1402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-933-5993
Provider Business Practice Location Address Fax Number:
305-933-9415
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  ME0072217 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 270864 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3099719 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: H12370 . This is a "VISTA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 130023051 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 33130 . This is a "NHP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7379174 . This is a "AETNA LIFE INS CO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7757600 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 51659 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 259003400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: N34556 . This is a "WELLCARE/STAYWELL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1024837 . This is a "CARE PLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 216735 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 400000501000 . This is a "PREFERRED CARE PARTNERS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 259003400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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