Crossroads Physician Corp

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

CROSSROADS PHYSICIAN CORP

Doing business as

Crossroads Internal Medicine #3

Practice address

1 Doctors Park Rd
Suite C
Mount Vernon, IL 62864-6251

Phone

(618) 242-1397

Fax

(618) 242-9002

NPI assigned

Dec 21, 2006

Last updated

Oct 30, 2007By the provider in NPPES

Organization subpart

Yes

Parent organization

CROSSROADS PHYSICIAN 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 2

Addresses

Other names 1

• Crossroads Internal Medicine #3 Doing business as

Part of

Kessler Family Pract

Locations

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193702400000",
    "number": "1679637789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 DOCTORS PARK RD",
            "address_2": "SUITE C",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646251",
            "telephone_number": "618-242-1397",
            "fax_number": "618-242-9002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 DOCTORS PARK RD",
            "address_2": "SUITE C",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646251",
            "telephone_number": "618-242-1397",
            "fax_number": "618-242-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS PHYSICIAN CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CROSSROADS PHYSICIAN CORP",
        "enumeration_date": "2006-12-21",
        "last_updated": "2007-10-30",
        "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": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Internal Medicine #3",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melanie Cross, FNP
• Crossroads Home Care Services, LLC (Mederi Caretenders)
• Crossroads Physician Corp
• Crossroads Physician Corp (Crossroads Surgical Associates)
• Crossroads Physician Corp (Crossroads Family Medicine of Mt Vernon)
• Crossroads Physician Corp (Crossroads Family Associates #2)
• Crossroads Physician Corp (Crossroads Family Associates #1)
• Crossroads Physician Corp (Crossroads Internal Medicine #1)
• Crossroads Physician Corp (Crossroads Internal Medicine #2)
• Crossroads Physicians Corp

• Internal Medicine Physician in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.