Crossroads Physician Corp

NPI #1679637789 in Mount Vernon, Illinois

Provider Information

NPI Number: 1679637789
Entity Type: Organization
Organization Name: Crossroads Physician Corp
Subpart: Yes (part of a larger organization)
Parent Organization: CROSSROADS PHYSICIAN CORP
Primary Specialty: Internal Medicine
Enumeration Date: Dec 21, 2006
Last Updated: Oct 30, 2007

Practice Location

Address: 1 DOCTORS PARK RD
Address 2: SUITE C
City: Mount Vernon
State: Illinois
ZIP Code: 62864-6251
Phone: (618) 242-1397

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X
Internal Medicine	207R00000X	Primary

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