Organization
CROSSROADS PHYSICIAN CORP
Active
Parent organization
CROSSROADS PHYSICIAN CORP
Other names
Crossroads Family Associates #1
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 120, MOUNT VERNON, IL 62864-6254
(618) 242-3119
(618) 242-3132
Mailing address
209 CROSSROADS PL, SUITE 120, MOUNT VERNON, IL 62864-6254
(618) 242-3119
(618) 242-3132
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
Other
Enumeration date
09/06/2005
Last updated
01/02/2008
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