Organization
CROSSROADS PHYSICIAN CORP
Active
Organization
CROSSROADS PHYSICIAN CORP
Active
Parent organization
CROSSROADS PHYSICIAN CORP
Other names
Crossroads Family Medicine of McLeansboro
Organization subpart
Yes
Provider details
NPI number
Legal business name
CROSSROADS PHYSICIAN CORP
Authorized official
DEBBIE E BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(877) 892-9813
Entity
Organization
Contact information
Practice address
208 S WASHINGTON STREET, MCLEANSBORO, IL 62859
(618) 643-2835
(618) 643-2891
Mailing address
208 S WASHINGTON STREET, MCLEANSBORO, IL 62859
(618) 643-2835
(618) 643-2891
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
IL
363A00000X
Physician Assistant
—
IL
363L00000X
Nurse Practitioner
—
IL
Other
Enumeration date
12/14/2006
Last updated
09/18/2007
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