Provider Demographics
NPI:1114654423
Name:CROSSROADS FAMILY HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:CROSSROADS FAMILY HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:662-286-2300
Mailing Address - Street 1:2427 PROPER ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-5394
Mailing Address - Country:US
Mailing Address - Phone:662-286-2300
Mailing Address - Fax:662-286-7010
Practice Address - Street 1:2427 PROPER ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-5394
Practice Address - Country:US
Practice Address - Phone:662-286-2300
Practice Address - Fax:662-286-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty