Crossroads Physician Corp
Clinic/Center, Rural Health in Mount Vernon, IL. Organization (NPI-2).
Details
- NPI
- 1669466686
- Entity type
- Organization (NPI-2)
- Legal business name
- Crossroads Physician Corp
- Organization subpart
- Yes
- Enumeration date
- Sep 6, 2005
- Last updated
- Aug 10, 2011
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR1300X | Clinic/Center, Rural Health | – | – | Yes |
Other names
- Crossroads Family Medicine Of Mt Vernon (Doing Business As)
Practice location
3505 Broadway StMount Vernon, IL 62864-2202
Phone 618-241-8772 · Fax 618-241-8775
Mailing address
Po Box 689022Franklin, TN 37068-9022
Phone 615-465-7626
Authorized official
Debbie Brewer
Director Of Provider Enrollment
6154657626
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 10 Rural Health Clinic/Center providers in Mount Vernon · All 834 providers in Mount Vernon
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