Crossroads Physician Corporation

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CROSSROADS PHYSICIAN CORPORATION

Doing business as

Crossroads Family Medicine of Okawville

Practice address

205 E Belleville
Okawville, IL 62271

Phone

(618) 243-5151

Fax

(618) 243-5220

NPI assigned

Sep 16, 2005

Last updated

Sep 19, 2007By the provider in NPPES

Organization subpart

Yes

Parent organization

CROSSROADS PHYSICIAN CORPORATIONAs 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 Okawville Doing business as

Part of

Crossroads Physician Corp

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

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190160000000",
    "number": "1184619033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 E BELLEVILLE",
            "city": "OKAWVILLE",
            "state": "IL",
            "postal_code": "62271",
            "telephone_number": "618-243-5151",
            "fax_number": "618-243-5220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 E BELLEVILLE",
            "city": "OKAWVILLE",
            "state": "IL",
            "postal_code": "62271",
            "telephone_number": "618-243-5151",
            "fax_number": "618-243-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS PHYSICIAN CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CROSSROADS PHYSICIAN CORPORATION",
        "enumeration_date": "2005-09-16",
        "last_updated": "2007-09-19",
        "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 Okawville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Okawville, IL
• Providers in Okawville, 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 Sep 19, 2007; 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.