| Crossroads Physician Corp | |
|
1209 W Robinson St Wayne City IL 62895-9672 | |
| (618) 895-2050 | |
| (618) 895-2056 |
| Full Name | Crossroads Physician Corp |
|---|---|
| Speciality | Family Medicine |
| Location | 1209 W Robinson St, Wayne City, Illinois |
| Authorized Official Name and Position | Sophia Arwood (DIRECTOR OF PROVIDER ENROLLMENT) |
| Authorized Official Contact | 6156286038 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crossroads Physician Corp 1209 W Robinson St Wayne City IL 62895-9672 Ph: (618) 895-2050 | Crossroads Physician Corp 1209 W Robinson St Wayne City IL 62895-9672 Ph: (618) 895-2050 |
| NPI Number | 1972597060 |
|---|---|
| Provider Enumeration Date | 09/06/2005 |
| Last Update Date | 09/19/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972597060 | NPI | - | NPPES |
| 036041176 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Illinois) | Primary |
| 363A00000X | Physician Assistant | (Illinois) | Secondary |
National Healthcare Of Mt Vernon Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1209 W Robinson St, Wayne City, IL 62895 Phone: 618-895-2050 Fax: 618-895-2056 | |
Deaconess Illinois Crossroads Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1209 W Robinson St, Wayne City, IL 62895 Phone: 618-895-2050 Fax: 618-895-2056 | |
National Healthcare Of Mt Vernon Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1209 W Robinson St, Wayne City, IL 62895 Phone: 618-895-2050 Fax: 618-895-2056 |