CROSSROADS PHYSICIAN CORP (NPI# 1669466686) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669466686 |
| Entity Type | Organization |
| Organization Name | CROSSROADS PHYSICIAN CORP |
| Other Organization Name | CROSSROADS FAMILY MEDICINE OF MT VERNON |
| Practice Address |
3505 Broadway St Mount Vernon IL 62864-2202 |
| Mailing Address |
Po Box 689022 Franklin TN 37068-9022 |
| Practice Telephone | 6182418772 |
| Practice Fax Number | 6182418775 |
| Mailing Telephone | 6154657626 |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2011-08-10 |
| Authorized Official Name | DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT) |
| Authorized Official Telephone | 6154657626 |
| Is Organization Subpart | Y |
| Parent Organization Name | CROSSROADS PHYSICIAN CORP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036041176 | 05 |
| Other Name | Type Code |
|---|---|
| Crossroads Family Medicine of Mt Vernon | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366504888 | Crossroads Physician Corp | Physician Assistant | 208 S Washington Street, Mcleansboro, IL 62859 | 2006-12-14 |
| 1871587881 | Crossroads Physician Corp | Internal Medicine | 1009 S 42nd St, Suite #2, Mount Vernon, IL 62864-6218 | 2005-09-06 |
| 1780678797 | Crossroads Physician Corp | Family Medicine | 209 Crossroads Pl, Suite 120, Mount Vernon, IL 62864-6254 | 2005-09-06 |
| 1972597060 | Crossroads Physician Corp | Physician Assistant | 1209 W Robinson St, Wayne City, IL 62895-9672 | 2005-09-06 |
| 1598759516 | Crossroads Physician Corp | Nurse Practitioner | 1325 W Whittaker St, Suite 3, Salem, IL 62881-2007 | 2005-09-06 |
| 1790779874 | Crossroads Physician Corp | Nurse Practitioner | 4101 N Water Tower Pl, Mount Vernon, IL 62864-6296 | 2005-09-06 |
| 1194980516 | Crossroads Physician Corp | Internal Medicine | 209 Crossroads Pl, Suite 140, Mount Vernon, IL 62864-6545 | 2008-07-24 |
| 1679637789 | Crossroads Physician Corp | Physician Assistant | 1 Doctors Park Rd, Suite C, Mount Vernon, IL 62864-6251 | 2006-12-21 |
| 1699769612 | Crossroads Physician Corp | Family Medicine | 209 Crossroads Pl, Suite 150, Mount Vernon, IL 62864-6254 | 2005-09-06 |
| 1417941436 | Crossroads Physician Corp | Surgery | 209 Crossroads Pl, Suite 130, Mount Vernon, IL 62864-6254 | 2005-09-06 |
| Street Address |
3505 BROADWAY ST |
| City | MOUNT VERNON |
| State | IL |
| Zip Code | 62864-2202 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023235348 | Anderson Family Practice | Clinic/Center | 3505 Broadway St, Mount Vernon, IL 62864-2202 | 2007-04-19 |
| 1558473645 | John Hall, M.d., P.C. | Family Medicine | 3505 Broadway St, Ste A, Mount Vernon, IL 62864-2202 | 2006-08-31 |
| 1053396622 | John T. Hall | Family Medicine | 3505 Broadway St, Ste A, Mount Vernon, IL 62864-2202 | 2005-12-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619438892 | Melissa Pryer | Dietitian, Registered | 2020 Broadway, Suite 1, Mt. Vernon, IL 62864 | 2019-03-28 |
| 1487145454 | Chiropractic Wellness Center of Mt Vernon, LLC. | Chiropractor | 1009 S 42nd St Ste 5, Mount Vernon, IL 62864 | 2018-05-24 |
| 1851889208 | Kimberly Tate | Counselor | 4110 North Water Place, Mt. Vernon, IL 62864 | 2018-05-01 |
| 1871907790 | University Hematology Oncology Inc | Specialist | #11 Cusumano Professional Plaza, Mount Vernon, IL 62864 | 2014-06-18 |
| 1457771677 | Dynamic Counseling and Consultation Services | Social Worker | 3600 S Water Tower Pl, Mt Vernon, IL 62864 | 2014-04-27 |
| 1619239431 | Judith C Morgan | Counselor | 16338 N Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-06-08 |
| 1073888624 | James Brian Verges | Counselor | 16338 N. Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-03-15 |
| 1720352271 | Lucinda M. Holdren | Counselor | 16338 North Illinois Highway 37, Mount Vernon, IL 62864 | 2012-03-01 |
| 1780978627 | Jamie M Orange | Physical Therapy Assistant | 19958 Fairfield Rd, Mt. Vernon, IL 62864 | 2011-06-08 |
| 1780978791 | Wendy Marie Claytor | Speech-Language Pathologist | 600 E Il Hwy 15, Mount Vernon, IL 62864 | 2011-06-07 |
| Find all providers in zip 62864 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396263000 | Rockcastle County Hospital, Inc. | Clinic/Center | 1770 Lake Cumberland Rd, Mount Vernon, KY 40456-8431 | 2017-09-01 |
| 1578090403 | Advanced Family Medical Clinic Mount Vernon | Clinic/Center | 50 Lovell Court, Mount Vernon, KY 40456-2964 | 2017-05-23 |
| 1306114004 | Lower Oconee Community Hospital, Inc | Clinic/Center | 421 W Robinson Dr, Mount Vernon, GA 30445-2935 | 2011-12-08 |
| 1871706374 | John Hall Md Rural Health Services | Clinic/Center | 3505 Broadway St Ste A, Mount Vernon, IL 62864-2202 | 2007-05-08 |
| 1164547287 | Lower Oconee Community Hospital, Inc | Clinic/Center | 441 W Broad Street, Mount Vernon, GA 30445-2629 | 2007-03-20 |
| 1497823314 | Southside Medical Clinic Inc | Clinic/Center | 913 South 10th Street, Mount Vernon, IL 62864-5313 | 2006-11-30 |
| 1548264237 | Physician Services Corp of Southern Illinois | Clinic/Center | 8 Cusumano Professional Plaza Dr, Mount Vernon, IL 62864-6736 | 2005-06-09 |
| 1912900234 | Family Care Network, Pllc | Clinic/Center | 2116 E. Section St., Mount Vernon, WA 98274 | 2005-05-31 |
| 1447814405 | National Healthcare of Mt Vernon Inc | Clinic/Center | 4101 N Water Tower Pl, Mount Vernon, IL 62864-6296 | 2019-04-25 |
| 1801280409 | Heartland Women's Healthcare, Ltd | Clinic/Center | 3130 Veterans Memorial Dr, Mount Vernon, IL 62864-5951 | 2015-03-23 |
| Find all providers in MOUNT VERNON | ||||
| City | MOUNT VERNON |
| Zip Code | 62864 |
Please comment or provide details below to improve the information on CROSSROADS PHYSICIAN CORP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.