Organization
CROSSROADS PHYSICIANS CORP
Active
Parent organization
CROSSROADS PHYSICIANS CORP
Other names
Crossroads Family Medicine of Benton #2
Organization subpart
Yes
Provider details
NPI number
Legal business name
CROSSROADS PHYSICIANS CORP
Authorized official
DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7626
Entity
Organization
Contact information
Practice address
203 BAILEY LN, BENTON, IL 62812-1969
(618) 438-3621
(618) 438-3622
Mailing address
203 BAILEY LN, BENTON, IL 62812-1969
(618) 438-3621
(618) 438-3622
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
Other
Enumeration date
04/24/2006
Last updated
01/02/2008
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