| Crossroads Telemedicine Pllc | |
|
3790 N Bellafont Blvd Ste 1 Fayetteville AR 72703-5481 | |
| (479) 439-0777 | |
| (888) 815-1613 |
| Full Name | Crossroads Telemedicine Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3790 N Bellafont Blvd Ste 1, Fayetteville, Arkansas |
| Authorized Official Name and Position | Thomas B De Miranda (OWNER) |
| Authorized Official Contact | 4792851255 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crossroads Telemedicine Pllc 3790 N Bellafont Blvd Ste 1 Fayetteville AR 72703-5481 Ph: (479) 439-0777 | Crossroads Telemedicine Pllc 3790 N Bellafont Blvd Ste 1 Fayetteville AR 72703-5481 Ph: (479) 439-0777 |
| NPI Number | 1285371021 |
|---|---|
| Provider Enumeration Date | 05/13/2022 |
| Last Update Date | 05/13/2022 |
| Medicare PECOS PAC ID | 3072991124 |
|---|---|
| Medicare Enrollment ID | O20220602001100 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285371021 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Danny Lynn Proffitt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306805379 PECOS PAC ID: 7012953524 Enrollment ID: I20050706001092 |
| Provider Name | Thomas De Miranda |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1689866725 PECOS PAC ID: 4981735636 Enrollment ID: I20100624000874 |
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