# CROSSROADS PHYSICIAN CORP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CROSSROADS PHYSICIAN CORP
- **Other names:** Crossroads Family Medicine of Mt Vernon
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1669466686
- **Legal business name:** CROSSROADS PHYSICIAN CORP
- **Authorized official:** DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
- **Authorized official phone:** (615) 465-7626

## Contact information

- **Practice address:** 3505 BROADWAY ST, MOUNT VERNON, IL 62864-2202
- **Practice address phone:** (618) 241-8772
- **Practice address fax:** (618) 241-8775
- **Mailing address:** PO BOX 689022, FRANKLIN, TN 37068-9022
- **Mailing address phone:** (615) 465-7626

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/06/2005
- **Last updated:** 08/10/2011