Crossroads Family Medicine Of Mt Vernon

LBN: Crossroads Physician Corp
Crossroads Family Medicine Of Mt Vernon is an health care organization with primary practice located at 3505 Broadway St , Mount Vernon IL 62864-2202. The organization recently has only one registered license in Ambulatory Health Care Facilities / Rural Health, which is considered as the primary health care specialty. Crossroads Physician Corp can be contacted via phone (618) 241-8772, or through Brewer, Debbie via phone (615) 465-7626.

Contact Information

Primary practice address
3505 Broadway St Mount Vernon IL 62864-2202
Fax: (618) 241-8775
Website:
Authorized official contact:
Name: Brewer, Debbie

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Rural Health 261QR1300X

Profile Details

NPI number 1669466686
LBN Legal business name Crossroads Physician Corp
DBA Doing business as Crossroads Family Medicine Of Mt Vernon
Authorized official Brewer, Debbie
Entity Organization
Organization subpart 1 Yes
Enumeration date Sep 6th, 2005
Last updated Aug 10th, 2011 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669466686 NPPES
Illinois MEDICAID 036041176

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