Organization
CROSSROADS URGENT CARE PLLC
Active
Other names
Urgent Team
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE MAULDIN (CFO)
(615) 988-2005
Entity
Organization
Contact information
Practice address
2395 LAKE RD, DYERSBURG, TN 38024-1831
(731) 882-1958
Mailing address
2395 LAKE RD, DYERSBURG, TN 38024-1831
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44-8949
CMS CERTIFICATION NUMBER
—
Enumeration date
06/29/2015
Last updated
07/05/2016
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