| Organization Name: | CROSS ROAD MEDICAL CENTER |
| NPI Number: | 1609871391 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOEL MEDENDORP (CEO) |
| Mailing Address: | Mile 187 Glenn Highway Glennallen |
| State: | AK US |
| Postal Code: | 995880589 |
| Phone Number: | 9078223203 |
| Fax Number: | 9078225805 |
| NPI Enumeration Date: | 06/17/2005 |
| NPI Last Update Date: | 09/24/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | 10300 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |