Organization
CROSSROADS PHYSICIAN CORP
Active
Parent organization
CROSSROADS PHYSICIAN CORP
Other names
Crossroads Internal Medicine #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
4101 N WATER TOWER PL, MOUNT VERNON, IL 62864-6296
(618) 244-4313
(618) 244-9592
Mailing address
4101 N WATER TOWER PL, MOUNT VERNON, IL 62864-6296
(618) 244-4313
(618) 244-9592
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
IL
363L00000X
Nurse Practitioner
—
IL
Other
Enumeration date
09/06/2005
Last updated
10/30/2007
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