Organization
CROSSROADS PHYSICIAN CORP
Active
Parent organization
CROSSROADS PHYSICIAN CORP
Other names
Crossroads Family Medicine of Salem
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
1325 W WHITTAKER ST, SUITE 3, SALEM, IL 62881-2007
(618) 548-4911
(618) 548-8052
Mailing address
1325 W WHITTAKER ST, SUITE 3, SALEM, IL 62881-2007
(618) 548-4911
(618) 548-8052
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
363L00000X
Nurse Practitioner
—
IL
Other
Enumeration date
09/06/2005
Last updated
09/18/2007
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