Crossroads Physician Corp

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CROSSROADS PHYSICIAN CORP

Doing business as

Crossroads Family Medicine of Wayne City

Practice address

1209 W Robinson St
Wayne City, IL 62895-9672

Phone

(618) 895-2050

Fax

(618) 895-2056

NPI assigned

Sep 6, 2005

Last updated

Sep 19, 2013By 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

Sophia Arwood

Title

Director of Provider Enrollment

Phone

(615) 628-6038

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Crossroads Family Medicine of Wayne City 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": "1379548800000",
    "number": "1972597060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1209 W ROBINSON ST",
            "city": "WAYNE CITY",
            "state": "IL",
            "postal_code": "628959672",
            "telephone_number": "618-895-2050",
            "fax_number": "618-895-2056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 W ROBINSON ST",
            "city": "WAYNE CITY",
            "state": "IL",
            "postal_code": "628959672",
            "telephone_number": "618-895-2050",
            "fax_number": "618-895-2056"
        }
    ],
    "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": "2013-09-19",
        "status": "A",
        "authorized_official_last_name": "ARWOOD",
        "authorized_official_first_name": "SOPHIA",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "615-628-6038"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036041176",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Family Medicine of Wayne City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bandys Apothecary Shops Inc (Bandy's Pharmacy II)
• Tiffany Blasdel
• Deaconess Illinois Crossroads Inc (Crossroads Family Medicine of Wayne City)
• Lisa K Feather, PA-C
• Sherry Charlette Locey, PA-C
• Kassi Dawn McCormick, PTA
• National Healthcare of Mt Vernon Inc (Crossroads Family Medicine of Wayne City)

• Family Medicine Physician in Wayne City, IL
• Providers in Wayne City, 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, 2013; 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.