Crossroads Physician Corp

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CROSSROADS PHYSICIAN CORP

Practice address

320 N Main St
Suite a
Benton, IL 62812-1313

Phone

(618) 439-6370

Fax

(618) 439-6490

NPI assigned

Sep 6, 2005

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 Medicine of Benton Doing business as

Part of

Crossroads Physicians C

Locations

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190160000000",
    "number": "1750375770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 N MAIN ST",
            "address_2": "SUITE A",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121313",
            "telephone_number": "618-439-6370",
            "fax_number": "618-439-6490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 N MAIN ST",
            "address_2": "SUITE A",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121313",
            "telephone_number": "618-439-6370",
            "fax_number": "618-439-6490"
        }
    ],
    "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": "2007-09-19",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Family Medicine of Benton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christopher Greater Area Rural Health Planning Corporation
• City of Benton
• Billie J Cox, LPN
• David Boyd Cox, MD
• Effaney Crain, MOTR/L
• Crossroads Physicians Corp
• Cameron Scott Cummins
• David F Szoke MD,
• David K. Spencer, O.D.
• Veronica Lynn Davison, LPN

• Family Medicine Physician in Benton, IL
• Providers in Benton, 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.