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Organization
CROSSROADS PHYSICIAN CORPORATION
Active
Organization
CROSSROADS PHYSICIAN CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7626
Entity
Organization
Contact information
Practice address
1245 S MILL ST, NASHVILLE, IL 62263-2004
(618) 327-9333
(618) 327-9022
Mailing address
7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
363A00000X
Physician Assistant
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036052179
—
IL
Enumeration date
09/15/2005
Last updated
04/27/2009
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