CROSSOVER COMMUNITY IMPACT, INC. (NPI# 1407297963) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407297963 |
| Entity Type | Organization |
| Organization Name | CROSSOVER COMMUNITY IMPACT, INC. |
| Other Organization Name | CROSSOVER HEALTH SERVICES, L.L.C. |
| Practice Address |
940 E 36th St N Tulsa OK 74106-1953 |
| Practice Telephone | 9183989460 |
| Practice Fax Number | 9183989460 |
| Mailing Telephone | 9183989460 |
| Mailing Fax Number | 9183989460 |
| Enumeration Date | 2013-07-12 |
| Last Update Date | 2014-04-04 |
| Authorized Official Name | DR. KENT G FARISH (PHYSICIAN) |
| Authorized Official Telephone | 9183989460 |
| Authorized Official Credential | M. D. |
| Is Organization Subpart | Y |
| Parent Organization Name | CROSSOVER COMMUNITY IMPACT, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | 14202 | OK | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100089530C | 05 | |
| OK | 200514040A | 05 |
| Other Name | Type Code |
|---|---|
| Crossover Health Services, L.L.C. | Other Name - Individual/Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CROSSOVER COMMUNITY IMPACT, INC. | 940 E 36th St N, Tulsa, OK 74106-1953 |
| Street Address |
940 E 36TH ST N |
| City | TULSA |
| State | OK |
| Zip Code | 74106-1953 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831176601 | Kent G Farish | Family Medicine | 940 E 36th St N, Tulsa, OK 74106-1953 | 2005-12-22 |
| 1093280364 | Crossover Counseling Services, LLC | Community/Behavioral Health | 940 E 36th St N, Tulsa, OK 74106-1953 | 2018-10-12 |
| 1821418773 | Sarah Janssen | Family Medicine | 940 E 36th St N, Tulsa, OK 74106-1953 | 2014-04-18 |
| 1184732570 | George Joseph Bovasso Jr. | Pediatrics | 940 E 36th St N, Tulsa, OK 74106-1953 | 2006-08-27 |
| 1649240037 | Rebecca Jeanne Brett | Family Medicine | 940 E 36th St N, Tulsa, OK 74106-1953 | 2006-01-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811538895 | Desma Johnson | Technician | 784 East 43rd Street North, Tulsa, OK 74106 | 2019-10-01 |
| 1912462094 | Breyan Lashawn Jackson | Case Manager/Care Coordinator | 3606 N Mlk Jr. Blvd, Tulsa, OK 74106 | 2019-02-04 |
| 1740751445 | Ernest Kaara Maina | Family Medicine | 3606 M.l.k. Jr Blvd, Tulsa, OK 74106 | 2018-12-07 |
| 1568969632 | A&m Healthcare Clinic | Nurse Practitioner | 3606 North Mlk Blvd, Tulsa, OK 74106 | 2018-04-06 |
| 1265880819 | Paula Patricia Tullis | Psychologist | 1232 N Boston, Tulsa, OK 74106 | 2016-05-24 |
| 1326413030 | Eartha Mcalester | Counselor | 628 E. Virgin St., Tulsa, OK 74106 | 2015-12-07 |
| 1114334182 | James O Brannon Jr. | Behavioral Analyst | 2745 North Main, Tulsa, OK 74106 | 2014-07-22 |
| 1952718512 | Teresa Marie Williams | Counselor | 3601 N. Martin Luther King Blvd, Tulsa, OK 74106 | 2014-07-16 |
| 1639580764 | Lynnette Dixon | Case Management | 708 East 38th Street North, Tulsa, OK 74106 | 2014-05-12 |
| 1184975898 | Tiara Delonia | Social Worker | 1 W 36th St N Suite 1, Tulsa, OK 74106 | 2012-09-21 |
| Find all providers in zip 74106 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427662170 | Osu Center for Health Sciences | Clinic/Center | 802 S Jackson Ave Ste 410, Tulsa, OK 74127-9059 | 2020-09-01 |
| 1356971071 | Management Worldwide, LLC | Clinic/Center | 4415 S Harvard Ave Ste 201, Tulsa, OK 74135-2618 | 2020-01-22 |
| 1477194488 | Adhd and Mood Center of Oklahoma | Clinic/Center | 6565 South Yale Ave, Suite 706, Tulsa, OK 74136 | 2019-10-01 |
| 1952957995 | Osu Center for Health Sciences | Clinic/Center | 10507 E 91st St Ste 550, Tulsa, OK 74133-5590 | 2019-08-15 |
| 1538639190 | Osu Center for Health Sciences | Clinic/Center | 6465 S. Yale Ave. Suite 514, Tulsa, OK 74136 | 2018-11-27 |
| 1437627031 | Osu Center for Health Sciences | Clinic/Center | 6475 S Yale Ave Ste 202, Tulsa, OK 74136-7819 | 2018-11-13 |
| 1063990398 | Rodi LLC | Clinic/Center | 8316 E 61st St Ste 101-aa, Tulsa, OK 74133-1910 | 2018-07-30 |
| 1134654627 | Auxarc Imc, Inc | Clinic/Center | 3421 E 21st St, Tulsa, OK 74114-1958 | 2017-04-22 |
| 1831507680 | Osu Center for Health Sciences | Clinic/Center | 5635 N Cincinnati Ave, Tulsa, OK 74126-2253 | 2014-07-24 |
| 1679996656 | Osu Center for Health Sciences | Clinic/Center | 700 N. Greenwood, #265nh, Tulsa, OK 74106-0702 | 2014-01-28 |
| Find all providers in TULSA | ||||
Please comment or provide details below to improve the information on CROSSOVER COMMUNITY IMPACT, INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.