Provider Demographics
NPI:1083952246
Name:CROSSGATES FAMILY DOCTORS
Entity Type:Organization
Organization Name:CROSSGATES FAMILY DOCTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:KROOSS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:601-932-3191
Mailing Address - Street 1:PO BOX 320609
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-0609
Mailing Address - Country:US
Mailing Address - Phone:601-932-3191
Mailing Address - Fax:
Practice Address - Street 1:395 CROSSGATES BLVD
Practice Address - Street 2:STE 102
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2768
Practice Address - Country:US
Practice Address - Phone:601-825-0003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty