NPIMap

Organization Active NPI

Crossroads Medical Center

  • Non-Pharmacy Dispensing Site
  • Shakopee, MN
National Provider Identifier
1902989239
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
27079 Issued in MN
Legal business name
CROSSROADS MEDICAL CENTER
Practice address
1335 10TH Ave E
Shakopee, MN 55379-2901
Phone
(952) 496-6700
Fax
(952) 445-6448
NPI assigned
Oct 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Direndia Shackelford
Title
Managed Care Specialist
Phone
(800) 654-0889

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 27079 MN Primary

Addresses

Primary practice location

1335 10TH Ave E
Shakopee, MN 55379-2901

Mailing address

1335 10TH Ave E
Shakopee, MN 55379-2901

Other identifiers 1

IdentifierTypeStateIssuer
2423692OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • CROSSROADS SHACKOPEE A Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Chaska Medical Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902989239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1335 10TH AVE E",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553792901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1335 10TH AVE E",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553792901",
            "telephone_number": "952-496-6700",
            "fax_number": "952-445-6448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHACKELFORD",
        "authorized_official_first_name": "DIRENDIA",
        "authorized_official_title_or_position": "MANAGED CARE SPECIALIST",
        "authorized_official_telephone_number": "800-654-0889"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "MN",
            "license": "27079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2423692",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CROSSROADS SHACKOPEE A",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shakopee, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.