Provider Demographics
NPI:1629186895
Name:CROSSROADS NEUROSURGICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:CROSSROADS NEUROSURGICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:NORVILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:361-827-0200
Mailing Address - Street 1:PO BOX 5311
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-5311
Mailing Address - Country:US
Mailing Address - Phone:361-827-0200
Mailing Address - Fax:
Practice Address - Street 1:2705 HOSPITAL DR
Practice Address - Street 2:SUITE 412
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5775
Practice Address - Country:US
Practice Address - Phone:361-827-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ 3562207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0830150 01Medicaid
TX0830150 01Medicaid
TX6392360001Medicare NSC