Organization
CROSSROADS PHYSICIANS CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA J FEY (SR. DIRECTOR PHYSICIAN REV CYCLE)
(615) 221-3641
Entity
Organization
Contact information
Practice address
209 CROSSROADS PL, SUITE 110, MOUNT VERNON, IL 62864-6254
(618) 244-6710
(618) 244-6779
Mailing address
1573 MALLORY LN STE 100, BRENTWOOD, TN 37027-2895
(152) 221-1400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
261QR1300X
Rural Health Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036064567
—
IL
01
—
4132020
BCBS IL
IL
Enumeration date
09/06/2005
Last updated
07/07/2023
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