NPIMap

Organization Active NPI

Crossroads Physician Corp

Doing business as Crossroads Family Associates #1

  • Family Medicine Physician
  • Mount Vernon, IL
National Provider Identifier
1780678797
Registry record updated Jan 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CROSSROADS PHYSICIAN CORP
Doing business as
Crossroads Family Associates #1
Practice address
209 Crossroads PL
Suite 120
Mount Vernon, IL 62864-6254
Phone
(618) 242-3119
Fax
(618) 242-3132
NPI assigned
Sep 6, 2005
Last updated
Jan 2, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
CROSSROADS PHYSICIAN CORPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 2, 2008

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

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X IL Primary

Addresses

Primary practice location

209 Crossroads PL
Suite 120
Mount Vernon, IL 62864-6254

Mailing address

209 Crossroads PL
Suite 120
Mount Vernon, IL 62864-6254
Phone (618) 242-3119

Other names 1

  • Crossroads Family Associates #1 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Crossroads Physician Corp2 organizations share this tax ID, including this one
Part of
Crossroads Physician Corp

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199232000000",
    "number": "1780678797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 CROSSROADS PL",
            "address_2": "SUITE 120",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646254",
            "telephone_number": "618-242-3119",
            "fax_number": "618-242-3132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 CROSSROADS PL",
            "address_2": "SUITE 120",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646254",
            "telephone_number": "618-242-3119",
            "fax_number": "618-242-3132"
        }
    ],
    "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": "2008-01-02",
        "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": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Family Associates #1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.