Provider Demographics
NPI:1598790552
Name:CROSSROADS AMBULATORY PROCEDURAL CENTER
Entity Type:Organization
Organization Name:CROSSROADS AMBULATORY PROCEDURAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:NWOFIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-331-5536
Mailing Address - Street 1:1805 WILLIAMSON CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7974
Mailing Address - Country:US
Mailing Address - Phone:615-331-5536
Mailing Address - Fax:615-331-3740
Practice Address - Street 1:1805 WILLIAMSON CT
Practice Address - Street 2:200
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7974
Practice Address - Country:US
Practice Address - Phone:615-331-5536
Practice Address - Fax:615-331-3740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN306722081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370373Medicare ID - Type Unspecified
TNG44132Medicare UPIN