Crossroads Physician Corp

NPI #1194980516 in Mount Vernon, Illinois

Provider Information

NPI Number: 1194980516
Entity Type: Organization
Organization Name: Crossroads Physician Corp
Primary Specialty: Family Medicine
Enumeration Date: Jul 24, 2008
Last Updated: Jul 28, 2008

Practice Location

Address: 209 CROSSROADS PL
Address 2: SUITE 140
City: Mount Vernon
State: Illinois
ZIP Code: 62864-6545
Phone: (618) 241-7207

Authorized Official

Name: DEBBIE T BREWER
Title: DIRECTOR
Phone: (615) 465-7626

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X
Nurse Practitioner	363L00000X
Family Medicine	207Q00000X	Primary

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