# CROSSROADS VIROLOGY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114755642
- **Authorized official:** PAIGE ASHLEIGH BOEHM (CLINIC MANAGER)
- **Authorized official phone:** (361) 571-7956

## Contact information

- **Practice address:** 1403 VICTORIA STATION DR, VICTORIA, TX 77901-3092
- **Practice address phone:** (361) 571-7956
- **Practice address fax:** (361) 214-1460
- **Mailing address:** 1403 VICTORIA STATION DR, VICTORIA, TX 77901-3092
- **Mailing address phone:** (361) 571-7956
- **Mailing address fax:** (361) 214-1460

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RI0200X | Infectious Disease Physician | — | NULL | Yes |
| 207RI0200X | Infectious Disease Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/25/2024
- **Last updated:** 07/25/2024