Crossroads Treatment Centers of Tennessee, PC
Organization Active NPI Clinic/Center · Memphis, TN
NPI 1104581040 · NPPES record last updated Nov 5, 2021
Key facts
- NPI
- 1104581040
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- CROSSROADS TREATMENT CENTERS OF TENNESSEE, PC
- Practice address
- 2605 S Nonconnah Blvd
Memphis, TN 38132-2144 - Phone
- (800) 805-6989
- NPI assigned
- Nov 5, 2021
- Organization subpart
- No
Authorized official
- Name
- Rupert McCormac IV, MD
- Title
- President
- Phone
- (800) 805-6989
Other NPIs on the same Medicare enrollment 13
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200213002831 | TN | Part B Supplier - Clinic/Group Practice | 6204262025 |
Receives reassigned benefits from 45 practitioners 13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tullahoma, TN; Sparta, TN; Oak Ridge, TN; Newport, TN; Morristown, TN; Johnson City, TN; Knoxville, TN; Jacksboro, TN… |
National Provider Directory
Locations
2605 S Nonconnah Blvd
Memphis, TN 38132
Phone (601) 522-6002
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | |||
| Clinic/Center | 261Q00000X | Yes | ||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Medically Fragile Infants and Children Day Care | 261QM3000X |
Addresses
Primary practice location
2605 S Nonconnah Blvd
Memphis, TN 38132-2144
Mailing address
200 E Broad St Ste 300
Greenville, SC 29601-2891
Phone (800) 805-6989
Other names
- Crossroads Treatment Centers Tennessee
Other providers in Memphis, TN
- Crossroads Chiropractic PA
- Crossroads Hospice of Tennessee
- Crossroads Hospice of Tennessee, LLC
- Crossroads Treatment Centers of Tennessee, P.C.
- Crossroads Treatment Centers of Tennessee, P.C.
- Crosstown Dental Group Highland Row LLC
- Crosstown Dental Group LLC
- Andrew W Crothers
- Sandra E. Crotts
- Billy Crouch
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.