Crossroads Urgent Care PLLC
Organization Active NPI Rural Health Clinic/Center · Tullahoma, TN
NPI 1306579008 · NPPES record last updated Mar 26, 2025
Key facts
- NPI
- 1306579008
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- CROSSROADS URGENT CARE PLLC
- Practice address
- 1802 N Jackson St Ste 850
Tullahoma, TN 37388-8237 - Phone
- (931) 563-5501
- Fax
- (931) 563-5503
- NPI assigned
- Jul 8, 2022
- Organization subpart
- No
Authorized official
- Name
- Stephanie Hicks
- Title
- Controller
- Phone
- (615) 988-2004
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 39
Practitioners 181
-
Naseem Ali, APRN
-
Avin Babanzadeh, NP
-
David Bartal, MS, AT-R, MSHS, PA-C
-
Donna Kaye Bearden, FNP-BC
-
Dona Maria Biggs, APRN FNP-C
-
Amy Bitely I, FNP
-
Jennifer Bober, APRN
-
James Wade Bolton, DC, APRN, FNP-C
-
Amber R Bonema, FNP-BC, ENP-C
-
Christopher Boyce, PA-C
-
Robert S Briggs, NP
-
Stacy R Bromley, PA-C
-
Matthew F Browning, M.D
-
Jamie Burrus, FNP-C
-
Season Bush, FNP-C
-
Tracy L. Carter, FNP-BC
-
Monika Checa, ARNP
-
Elizabeth Scott Chiu, APRN
-
Sarah Churchill, PA
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2053586 | Crossroads Urgent Care, PLLC | Certificate of waiver | Feb 3, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Rural health clinic certification: CCN 883923
- Legal name
- CROSSROADS URGENT CARE PLLC
- Doing business as
- ASCENSION SAINT THOMAS URGENT CARE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Nov 17, 2022
- Last certification
- Nov 17, 2022
- Ownership / control type
- 1B
- Organization structure
- Corporation · Proprietary
- Incorporated
- Jul 26, 2006 in TN
- Enrollment address
- 1802 N Jackson St
Ste 850
Tullahoma, TN 37388-8237
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Stephanie Hicks |
Corporate Director |
Dec 3, 2024 | |
| W-2 Managing Employee |
Dec 3, 2024 | ||
| Rudy L Blank |
Corporate Director |
Oct 1, 2017 | |
| Kaylan Kirby |
W-2 Managing Employee |
Oct 1, 2017 | |
| William E Meadows |
5% Or Greater Direct Ownership Interest |
May 16, 2016 | 100% |
| Crystal Gibson |
W-2 Managing Employee |
Jun 6, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220815002942 | TN | Part a Provider - Rural Health Clinic | 8325117484 | Practice locations: Tullahoma, TN |
National Provider Directory
- Tax ID family
- Crossroads Urgent Care PLLC
Locations
1802 N Jackson St
Ste 850
Tullahoma, TN 37388
Phone (931) 563-5501
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Primary Care Clinic/Center | 261QP2300X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes | ||
| Urgent Care Clinic/Center | 261QU0200X | |||
| Physician Assistant |
363A00000X | |||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
1802 N Jackson St Ste 850
Tullahoma, TN 37388-8237
Mailing address
30 Burton Hills Blvd Ste 175
Nashville, TN 37215-6403
Phone (615) 864-8709
Other names
- Urgent Team
Other providers in Tullahoma, TN
- John Dennie Crabtree Jr.
- Allen R Craig
- Jan Leslie Crean
- Clark Eugene Cressman
- Tiffany Dawn Crews
- Crown Surgery Center, LLC
- Deja Lynn Crutcher
- Shirley Rebecca Crutchfield
- Cumberland Pain Center, PLLC
- Cumberland Radiation Associates LLC
All providers in Tullahoma, TN · Rural Health Clinic/Center in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2025. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.