Crossroads Physician Corp

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

CROSSROADS PHYSICIAN CORP

Practice address

4101 N Water Tower PL
Mount Vernon, IL 62864-6296

Phone

(618) 244-4313

Fax

(618) 244-9592

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 2

Addresses

Other names 1

• Crossroads Internal Medicine #1 Doing business as

Part of

Crossroads Physicians C

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193702400000",
    "number": "1790779874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 N WATER TOWER PL",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646296",
            "telephone_number": "618-244-4313",
            "fax_number": "618-244-9592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 N WATER TOWER PL",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646296",
            "telephone_number": "618-244-4313",
            "fax_number": "618-244-9592"
        }
    ],
    "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": "2007-10-30",
        "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": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Internal Medicine #1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Crossroads Physician Corp
• Crossroads Physician Corp
• Crossroads Physician Corp
• Crossroads Physician Corp
• Crossroads Physician Corp
• Crossroads Physician Corp
• Crossroads Physicians Corp
• Ryan Crouse
• Gabrielle Cultice
• Twana Sue Curry, L.C.S.W.

• 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.