1932262367 NPI number — DR. DAVID LEE CROSS PT CRC EDD

Table of content: MR. SEAN ALEXANDER NYCPS (NPI 1366057507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932262367 NPI number — DR. DAVID LEE CROSS PT CRC EDD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROSS
Provider First Name:
DAVID
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT CRC EDD
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:
1932262367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8330 NAAB ROAD
Provider Second Line Business Mailing Address:
SUITE 311
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46260-1932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-872-1501
Provider Business Mailing Address Fax Number:
317-872-1507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8330 NAAB ROAD
Provider Second Line Business Practice Location Address:
SUITE 311 INDIANAPOLIS REHABILITATION AGENCY
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46260-1932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-872-1501
Provider Business Practice Location Address Fax Number:
317-872-1507
Provider Enumeration Date:
12/18/2006

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: 225100000X , with the licence number:  05001687A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: I010338 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 351642282 . This is a "OTHER PREFERRED NETWORKS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000188416 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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