Crossroads Physician Corp

NPI #1780678797 in Mount Vernon, Illinois

Provider Information

NPI Number: 1780678797
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: Jan 2, 2008

Practice Location

Address: 209 CROSSROADS PL
Address 2: SUITE 120
City: Mount Vernon
State: Illinois
ZIP Code: 62864-6254
Phone: (618) 242-3119

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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