| Crossroads Internal Medicine #1 | |
|
4101 N Water Tower Pl Mount Vernon IL 62864-6296 | |
| (618) 244-4313 | |
| (618) 244-9592 |
| Full Name | Crossroads Internal Medicine #1 |
|---|---|
| Speciality | Internal Medicine |
| Location | 4101 N Water Tower Pl, Mount Vernon, Illinois |
| Authorized Official Name and Position | Debbie T 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 Internal Medicine #1 4101 N Water Tower Pl Mount Vernon IL 62864-6296 Ph: (618) 244-4313 | Crossroads Internal Medicine #1 4101 N Water Tower Pl Mount Vernon IL 62864-6296 Ph: (618) 244-4313 |
| NPI Number | 1790779874 |
|---|---|
| Provider Enumeration Date | 09/06/2005 |
| Last Update Date | 10/30/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790779874 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Illinois) | Primary |
| 363L00000X | Nurse Practitioner | (Illinois) | Secondary |
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