| Crossroads Family Medicine Of Mt Vernon | |
|
3505 Broadway St Mount Vernon IL 62864-2202 | |
| (618) 241-8772 | |
| (618) 241-8775 |
| Full Name | Crossroads Family Medicine Of Mt Vernon |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 3505 Broadway St, Mount Vernon, Illinois |
| Authorized Official Name and Position | Debbie Brewer (DIRECTOR OF PROVIDER ENROLLMENT) |
| Authorized Official Contact | 6154657626 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crossroads Family Medicine Of Mt Vernon Po Box 689022 Franklin TN 37068-9022 Ph: (615) 465-7626 | Crossroads Family Medicine Of Mt Vernon 3505 Broadway St Mount Vernon IL 62864-2202 Ph: (618) 241-8772 |
| NPI Number | 1669466686 |
|---|---|
| Provider Enumeration Date | 09/06/2005 |
| Last Update Date | 08/10/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669466686 | NPI | - | NPPES |
| 036041176 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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