Provider Demographics
NPI:1053374454
Name:CROSS, TRENT WADE (MD)
Entity type:Individual
Prefix:DR
First Name:TRENT
Middle Name:WADE
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:PO BOX 4937
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-4937
Mailing Address - Country:US
Mailing Address - Phone:423-286-3400
Mailing Address - Fax:423-286-3402
Practice Address - Street 1:20405 ALBERTA ST
Practice Address - Street 2:SUITE A
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-3509
Practice Address - Country:US
Practice Address - Phone:423-286-3400
Practice Address - Fax:423-286-3402
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000038983207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00733990OtherMEDICARE RAILROAD
TN4230308OtherBLUECROSS AND BLUESHIELD
KY7100002510Medicaid
TN4230308OtherBLUECROSS AND BLUESHIELD
TN33381882Medicare PIN