| Crossroads Internal Medicine #2 | |
|
1009 S 42nd St Suite #2 Mount Vernon IL 62864-6218 | |
| (618) 246-0400 | |
| (618) 246-9550 |
| Full Name | Crossroads Internal Medicine #2 |
|---|---|
| Speciality | Internal Medicine |
| Location | 1009 S 42nd St, 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 #2 1009 S 42nd St Suite #2 Mount Vernon IL 62864-6218 Ph: (618) 246-0400 | Crossroads Internal Medicine #2 1009 S 42nd St Suite #2 Mount Vernon IL 62864-6218 Ph: (618) 246-0400 |
| NPI Number | 1871587881 |
|---|---|
| Provider Enumeration Date | 09/06/2005 |
| Last Update Date | 09/18/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871587881 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Illinois) | Primary |
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