Crossroads Clinic PLLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

CROSSROADS CLINIC PLLC

Practice address

1667 Ooltewah Ringgold Rd
Suite 111
Ooltewah, TN 37363-9830

Phone

(423) 825-4881

Fax

(423) 825-4882

NPI assigned

Jul 7, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Susan Vergot, MD

Title

Owner

Phone

(423) 902-0681

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467849600000",
    "number": "1043662687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1667 OOLTEWAH RINGGOLD RD",
            "address_2": "SUITE 111",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373639830",
            "telephone_number": "423-825-4881",
            "fax_number": "423-825-4882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1667 OOLTEWAH RINGGOLD RD",
            "address_2": "SUITE 111",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373639830",
            "telephone_number": "423-825-4881",
            "fax_number": "423-825-4882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-07",
        "last_updated": "2016-07-07",
        "status": "A",
        "authorized_official_last_name": "VERGOT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-902-0681",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Nurse Practitioner in Ooltewah, TN
• Providers in Ooltewah, TN by specialty
• Primary Care Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.