Provider Demographics
NPI:1679784466
Name:CROSSVILLE GYNECOLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:CROSSVILLE GYNECOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:PERRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-484-0042
Mailing Address - Street 1:PO BOX 2929
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38557-2929
Mailing Address - Country:US
Mailing Address - Phone:931-484-0042
Mailing Address - Fax:931-456-2472
Practice Address - Street 1:448 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4981
Practice Address - Country:US
Practice Address - Phone:931-484-0042
Practice Address - Fax:931-456-2472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1679784466OtherNPI CROSSVILLE GYNECOLOGY
TN1609962828OtherNPI MICHAEL PERRIGAN
TN3021328Medicaid
TN3373884Medicare ID - Type Unspecified