| Crossroads Telemedicine Pllc | |
|
199 N 34th St Rogers AR 72756-0304 | |
| (479) 845-7000 | |
| Not Available |
| Full Name | Crossroads Telemedicine Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 199 N 34th St, Rogers, Arkansas |
| Authorized Official Name and Position | Catherine Bohannan (OFFICE MANAGER) |
| Authorized Official Contact | 4798457000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crossroads Telemedicine Pllc Po Box 1784 Bentonville AR 72712-1784 Ph: () - | Crossroads Telemedicine Pllc 199 N 34th St Rogers AR 72756-0304 Ph: (479) 845-7000 |
| NPI Number | 1679180624 |
|---|---|
| Provider Enumeration Date | 09/24/2020 |
| Last Update Date | 11/30/2021 |
| Medicare PECOS PAC ID | 4385064096 |
|---|---|
| Medicare Enrollment ID | O20201019003047 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679180624 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (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 |
| Provider Name | Amy M Deatherage |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720489032 PECOS PAC ID: 4486970225 Enrollment ID: I20150313000485 |
| Provider Name | John Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689061129 PECOS PAC ID: 9830403302 Enrollment ID: I20150729007510 |
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