# CROSSROADS MEDICAL MANAGEMENT LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cohesive Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780011874
- **Authorized official:** MR. RANDY KERR (VP OF OPERATIONS)
- **Authorized official phone:** (405) 873-8268

## Contact information

- **Practice address:** 2508 N HARRISON ST, SHAWNEE, OK 74804-3131
- **Practice address phone:** (405) 585-2030
- **Practice address fax:** (405) 585-0318
- **Mailing address:** PO BOX 646022, DALLAS, TX 75264-6022
- **Mailing address phone:** (405) 873-8291
- **Mailing address fax:** (405) 857-3122

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 19091 | NULL | Yes |
| 207Q00000X | Family Medicine Physician | 19091 | — | Yes |

## Other

- **Enumeration date:** 10/03/2013
- **Last updated:** 10/29/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100131940B | — | OK |