Organization
CROSSROADS MEDICAL CENTER
Active
Other names
CROSSROADS SHACKOPEE A
Organization subpart
No
Provider details
NPI number
Authorized official
DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
(800) 654-0889
Entity
Organization
Contact information
Practice address
1335 10TH AVE E, SHAKOPEE, MN 55379-2901
(952) 496-6700
(952) 445-6448
Mailing address
1335 10TH AVE E, SHAKOPEE, MN 55379-2901
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
27079
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2423692
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/23/2006
Last updated
08/22/2020
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