Crossroads Physicians Corp

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CROSSROADS PHYSICIANS CORP

Doing business as

Crossroads Family Medicine of Benton #2

Practice address

203 Bailey LN
Benton, IL 62812-1969

Phone

(618) 438-3621

Fax

(618) 438-3622

NPI assigned

Apr 24, 2006

Last updated

Jan 2, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

CROSSROADS PHYSICIANS CORPAs reported in NPPES

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

Authorized official

Name

Debbie T Brewer

Title

Director of Provider Enrollment

Phone

(615) 465-7626

Specialties & licenses 1

Addresses

Other names 1

• Crossroads Family Medicine of Benton #2 Doing business as

Tax ID family

Kessler Family Pract2 organizations share this tax ID, including this one

Part of

Kessler Family Pract

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Crossroads Physician Corp

  dba Crossroads Family Associates #1

  • Family Medicine Physician
  • Mount Vernon, IL
  • NPI 1780678797
  NPD tax ID

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

{
    "created_epoch": "1145836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199232000000",
    "number": "1144286717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 BAILEY LN",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121969",
            "telephone_number": "618-438-3621",
            "fax_number": "618-438-3622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 BAILEY LN",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121969",
            "telephone_number": "618-438-3621",
            "fax_number": "618-438-3622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS PHYSICIANS CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CROSSROADS PHYSICIANS CORP",
        "enumeration_date": "2006-04-24",
        "last_updated": "2008-01-02",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "615-465-7626"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Family Medicine of Benton #2",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• City of Benton (City of Benton Fire Department)
• Billie J Cox, LPN
• David Boyd Cox, MD
• Effaney Crain, MOTR/L
• Crossroads Physician Corp (Crossroads Family Medicine of Benton)
• Cameron Scott Cummins
• David F Szoke MD, (Community Healthcare Clinic)
• David K. Spencer, O.D.
• Veronica Lynn Davison, LPN
• Dawn a Jackson-Breeden DMD LTD

• Family Medicine Physician in Benton, IL
• Providers in Benton, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2008; 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.