1801654744 NPI number — CROSSROADS MEDICAL GROUP, PLLC

Table of content: (NPI 1801654744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801654744 NPI number — CROSSROADS MEDICAL GROUP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSSROADS MEDICAL GROUP, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
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Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1801654744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 RESERVE BLVD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING HILL
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37174-3101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 RESERVE BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING HILL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37174-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-499-7244
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2024

Additional Information

Authorized Official

Authorized Official Last Name:
SMILEY
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
RCM
Authorized Official Telephone Number:
828-735-2822

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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