Crossroads Physician Corp

NPI #1598759516 in Salem, Illinois

Provider Information

NPI Number: 1598759516
Entity Type: Organization
Organization Name: Crossroads Physician Corp
Subpart: Yes (part of a larger organization)
Parent Organization: CROSSROADS PHYSICIAN CORP
Primary Specialty: Family Medicine
Enumeration Date: Sep 6, 2005
Last Updated: Sep 18, 2007

Practice Location

Address: 1325 W WHITTAKER ST
Address 2: SUITE 3
City: Salem
State: Illinois
ZIP Code: 62881-2007
Phone: (618) 548-4911

Authorized Official

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

Specialties & Taxonomy Codes

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

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