Crossroads Physician Corp

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CROSSROADS PHYSICIAN CORP

Practice address

209 Crossroads PL
Suite 140
Mount Vernon, IL 62864-6545

Phone

(618) 241-7207

Fax

(618) 241-7210

NPI assigned

Jul 24, 2008

Organization subpart

No

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

Authorized official

Name

Debbie T Brewer

Title

Director

Phone

(615) 465-7626

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1216857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217203200000",
    "number": "1194980516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 CROSSRODS PL",
            "address_2": "SUITE 140",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646545",
            "telephone_number": "618-241-7207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 CROSSROADS PL",
            "address_2": "SUITE 140",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646545",
            "telephone_number": "618-241-7207",
            "fax_number": "618-241-7210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS PHYSICIAN CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-24",
        "last_updated": "2008-07-28",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "615-465-7626"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Ellnetta Cox, APRN, FNP-BC
• Jean Anne Cralley
• Carrie Caroline Crocker, MSW, LCSW
• Melanie Cross, FNP
• Crossroads Home Care Services, LLC (Mederi Caretenders)
• Crossroads Physician Corp (Crossroads Surgical Associates)
• Crossroads Physician Corp (Crossroads Family Medicine of Mt Vernon)
• Crossroads Physician Corp (Crossroads Internal Medicine #3)
• Crossroads Physician Corp (Crossroads Family Associates #2)
• Crossroads Physician Corp (Crossroads Family Associates #1)

• Family Medicine Physician in Mount Vernon, IL
• Providers in Mount Vernon, 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 Jul 28, 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.