Provider Demographics
NPI:1154656916
Name:CROSSROADS MEDICAL SUPPLY,INC.
Entity Type:Organization
Organization Name:CROSSROADS MEDICAL SUPPLY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-791-6644
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:205 W. JOLIET HWY.
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-0275
Mailing Address - Country:US
Mailing Address - Phone:815-791-6644
Mailing Address - Fax:
Practice Address - Street 1:205 W JOLIET HWY
Practice Address - Street 2:205 W. JOLIET HWY.
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2111
Practice Address - Country:US
Practice Address - Phone:815-791-6644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies