Provider Demographics
NPI:1083280820
Name:CROSSROADS MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:CROSSROADS MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CALK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-353-3969
Mailing Address - Street 1:207 E GREENWOOD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:TX
Mailing Address - Zip Code:76230-3041
Mailing Address - Country:US
Mailing Address - Phone:940-353-3969
Mailing Address - Fax:940-386-5014
Practice Address - Street 1:207 EAST GREENWOOD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230
Practice Address - Country:US
Practice Address - Phone:940-735-1736
Practice Address - Fax:940-386-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies