Crossroads Physician Corp

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CROSSROADS PHYSICIAN CORP

Doing business as

Crossroads Family Associates #2

Practice address

209 Crossroads PL
Suite 150
Mount Vernon, IL 62864-6254

Phone

(618) 244-6222

Fax

(618) 244-7299

NPI assigned

Sep 6, 2005

Last updated

Sep 18, 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 1

Addresses

Other names 1

• Crossroads Family Associates #2 Doing business as

Part of

Crossroads Physician Corp

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190073600000",
    "number": "1699769612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 CROSSROADS PL",
            "address_2": "SUITE 150",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646254",
            "telephone_number": "618-244-6222",
            "fax_number": "618-244-7299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 CROSSROADS PL",
            "address_2": "SUITE 150",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646254",
            "telephone_number": "618-244-6222",
            "fax_number": "618-244-7299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS PHYSICIAN CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CROSSROADS PHYSICIAN CORP",
        "enumeration_date": "2005-09-06",
        "last_updated": "2007-09-18",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Family Associates #2",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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 Internal Medicine #3)
• Crossroads Physician Corp (Crossroads Family Associates #1)
• Crossroads Physician Corp (Crossroads Internal Medicine #1)
• Crossroads Physician Corp (Crossroads Internal Medicine #2)
• Crossroads Physicians Corp
• Ryan Crouse

• 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 Sep 18, 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.