Organization
CROSSROADS PHYSICIAN CORP
Active
Parent organization
CROSSROADS PHYSICIAN CORP
Other names
Crossroads Family Medicine of Wayne City
Organization subpart
Yes
Provider details
NPI number
Legal business name
CROSSROADS PHYSICIAN CORP
Authorized official
SOPHIA ARWOOD (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 628-6038
Entity
Organization
Contact information
Practice address
1209 W ROBINSON ST, WAYNE CITY, IL 62895-9672
(618) 895-2050
(618) 895-2056
Mailing address
1209 W ROBINSON ST, WAYNE CITY, IL 62895-9672
(618) 895-2050
(618) 895-2056
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
363A00000X
Physician Assistant
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036041176
—
IL
Enumeration date
09/06/2005
Last updated
09/19/2013
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