Organization
CROSSROADS PHYSICIAN CORP
Active
Parent organization
CROSSROADS PHYSICIAN CORP
Other names
Crossroads Surgical Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
CROSSROADS PHYSICIAN CORP
Authorized official
DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7626
Entity
Organization
Contact information
Practice address
209 CROSSROADS PL, SUITE 130, MOUNT VERNON, IL 62864-6254
(618) 242-3831
(618) 242-3375
Mailing address
209 CROSSROADS PL, SUITE 130, MOUNT VERNON, IL 62864-6254
(618) 242-3831
(618) 242-3375
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
IL
Other
Enumeration date
09/06/2005
Last updated
10/30/2007
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