| Organization Name: | CROSSVILLE MEDICAL GROUP PA |
| NPI Number: | 1053414698 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY BURTON (ADMINISTRATOR) |
| Mailing Address: | 100 Lantana Rd Suite 202 Crossville |
| State: | TN US |
| Postal Code: | 385551903 |
| Phone Number: | 9314845141 |
| Fax Number: | 9314845620 |
| NPI Enumeration Date: | 09/07/2006 |
| NPI Last Update Date: | 11/19/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |