| Crossroads Physician Corp | |
|
208 S Washington Street Mcleansboro IL 62859 | |
| (618) 643-2835 | |
| (618) 643-2891 |
| Full Name | Crossroads Physician Corp |
|---|---|
| Speciality | Internal Medicine |
| Location | 208 S Washington Street, Mcleansboro, Illinois |
| Authorized Official Name and Position | Debbie E Brewer (DIRECTOR OF PROVIDER ENROLLMENT) |
| Authorized Official Contact | 8778929813 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crossroads Physician Corp 208 S Washington Street Mcleansboro IL 62859 Ph: (618) 643-2835 | Crossroads Physician Corp 208 S Washington Street Mcleansboro IL 62859 Ph: (618) 643-2835 |
| NPI Number | 1366504888 |
|---|---|
| Provider Enumeration Date | 12/14/2006 |
| Last Update Date | 09/18/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366504888 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Illinois) | Primary |
| 363A00000X | Physician Assistant | (Illinois) | Secondary |
| 363L00000X | Nurse Practitioner | (Illinois) | Secondary |
Hamilton Memorial Hospital District Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 611 S Marshall Avenue, Mcleansboro, IL 62859 Phone: 618-643-2361 Fax: 618-643-2875 |