| Crossroads Physicians Corp | |
|
209 Crossroads Pl Suite 110 Mount Vernon IL 62864-6254 | |
| (618) 244-6710 | |
| (618) 244-6779 |
| Full Name | Crossroads Physicians Corp |
|---|---|
| Speciality | Family Medicine |
| Location | 209 Crossroads Pl, Mount Vernon, Illinois |
| Authorized Official Name and Position | Laura J Fey (SR. DIRECTOR PHYSICIAN REV CYCLE) |
| Authorized Official Contact | 6152213641 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crossroads Physicians Corp 1573 Mallory Ln Ste 100 Brentwood TN 37027-2895 Ph: (152) 221-1400 | Crossroads Physicians Corp 209 Crossroads Pl Suite 110 Mount Vernon IL 62864-6254 Ph: (618) 244-6710 |
| NPI Number | 1508850520 |
|---|---|
| Provider Enumeration Date | 09/06/2005 |
| Last Update Date | 07/07/2023 |
| Medicare PECOS PAC ID | 4385539642 |
|---|---|
| Medicare Enrollment ID | O20040217000409 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508850520 | NPI | - | NPPES |
| 036064567 | Medicaid | IL | |
| 4132020 | Other | IL | BCBS IL |
| Provider Name | Rodney L Miller |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750382396 PECOS PAC ID: 2860393428 Enrollment ID: I20040116000250 |
| Provider Name | Zaki H Chowdhury |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366456022 PECOS PAC ID: 1456345669 Enrollment ID: I20040412000753 |
| Provider Name | Gary M Reagan |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1417909060 PECOS PAC ID: 9133188121 Enrollment ID: I20041006000192 |
| Provider Name | Frank M Eaton |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1962419614 PECOS PAC ID: 4082609854 Enrollment ID: I20060406000465 |
| Provider Name | Anthony C Vacca |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497797401 PECOS PAC ID: 3173628864 Enrollment ID: I20070425000560 |
| Provider Name | Jeffrey B Mcintosh |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1790754075 PECOS PAC ID: 9830277037 Enrollment ID: I20090114000531 |
| Provider Name | William D Huffstutler |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578513420 PECOS PAC ID: 7517097801 Enrollment ID: I20100614000089 |
| Provider Name | Mohamed Ruzaik Ibrahim |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1235309527 PECOS PAC ID: 4082786942 Enrollment ID: I20111028000247 |
| Provider Name | Suzanne E Alt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811995566 PECOS PAC ID: 9931124781 Enrollment ID: I20111117000327 |
| Provider Name | Jeanne E Holdren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497860811 PECOS PAC ID: 7315161593 Enrollment ID: I20140609001296 |
| Provider Name | Khalid Naseer |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1851341366 PECOS PAC ID: 9335177047 Enrollment ID: I20150630001727 |
| Provider Name | Jeffrey Larson |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1013166990 PECOS PAC ID: 4082857594 Enrollment ID: I20150730011958 |
| Provider Name | Gregory Dalencourt |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1013185842 PECOS PAC ID: 5698853919 Enrollment ID: I20160831002792 |
| Provider Name | Peter J Mulhern |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1417932005 PECOS PAC ID: 6800843640 Enrollment ID: I20180313000836 |
| Provider Name | Cynthia Dawn Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841785185 PECOS PAC ID: 9739439720 Enrollment ID: I20180913000004 |
| Provider Name | Tyler Rueter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457824690 PECOS PAC ID: 4981946647 Enrollment ID: I20190429001221 |
| Provider Name | Carla R. Rogers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417555897 PECOS PAC ID: 3173934692 Enrollment ID: I20201204000154 |
Deaconess Il Specialty 4117 Water Tower Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4117 S Water Tower Pl Ste C, Mount Vernon, IL 62864 Phone: 618-242-0672 Fax: 618-242-0862 | |
Anderson Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3505 Broadway St, Mount Vernon, IL 62864 Phone: 618-244-7788 Fax: 618-244-9330 | |
Deaconess Illinois Clinic, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4105 N Water Tower Pl, Mount Vernon, IL 62864 Phone: 812-450-6815 | |
Deaconess Illinois Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4117 S Water Tower Pl, Mount Vernon, IL 62864 Phone: 618-242-0672 Fax: 618-242-0862 | |
Deaconess Illinois Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4113 S Water Tower Pl, Mount Vernon, IL 62864 Phone: 618-241-9071 Fax: 618-241-9079 | |
King City Physician Company, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4117 S Water Tower Pl, Suite C, Mount Vernon, IL 62864 Phone: 618-242-0672 Fax: 618-242-0862 | |
Crossroads Physician Corp Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 209 Crossroads Pl, Suite 140, Mount Vernon, IL 62864 Phone: 618-241-7207 Fax: 618-241-7210 |