# CROSSROADS MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Crossroads Medical Center LLC, Carl A Mortiz JR MBR
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164048161
- **Authorized official:** MS. LAUREN JASILLI FNP-C (PRACTICE OWNER)
- **Authorized official phone:** (303) 444-6400

## Contact information

- **Practice address:** 2760 29TH ST STE 2B, BOULDER, CO 80301-1221
- **Practice address phone:** (303) 444-6400
- **Practice address fax:** (303) 444-6465
- **Mailing address:** 2760 29TH ST STE 2B, BOULDER, CO 80301-1221
- **Mailing address phone:** (303) 444-6400
- **Mailing address fax:** (303) 444-6465

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/25/2020
- **Last updated:** 09/27/2024