Provider Demographics
NPI:1578823506
Name:CROSSROADS URGENT CARE PLLC
Entity Type:Organization
Organization Name:CROSSROADS URGENT CARE PLLC
Other - Org Name:WELLNOW URGENT CARE OF PORTLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:615-988-2012
Mailing Address - Street 1:30 BURTON HILLS BOULEVARD
Mailing Address - Street 2:SUITE 576
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6183
Mailing Address - Country:US
Mailing Address - Phone:615-988-2000
Mailing Address - Fax:615-891-1668
Practice Address - Street 1:121 VILLAGE DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1418
Practice Address - Country:US
Practice Address - Phone:615-325-2226
Practice Address - Fax:615-325-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care