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Organization

CROSSROADS PHYSICIAN CORP

Active
Parent organization
CROSSROADS PHYSICIAN CORP
Other names
Crossroads Family Medicine of Benton
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
320 N MAIN ST, SUITE A, BENTON, IL 62812-1313
(618) 439-6370
(618) 439-6490
Mailing address
320 N MAIN ST, SUITE A, BENTON, IL 62812-1313
(618) 439-6370
(618) 439-6490

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
IL

Other

Enumeration date
09/06/2005
Last updated
09/19/2007
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