Crossroads Physician Corp
NPI #1790779874 in Mount Vernon, Illinois
Provider Information
- NPI Number
- 1790779874
- 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
- Sep 6, 2005
- Last Updated
- Oct 30, 2007
Practice Location
- Address
- 4101 N WATER TOWER PL
- City
- Mount Vernon
- State
- Illinois
- ZIP Code
- 62864-6296
- Phone
- (618) 244-4313
Authorized Official
- Name
- DEBBIE T BREWER
- Title
- DIRECTOR OF PROVIDER ENROLLMENT
- Phone
- (615) 465-7626
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner |
| Internal Medicine |
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