Provider Demographics
NPI:1710162128
Name:CROSSROADS MEDICAL CONSULTANTS LLC
Entity Type:Organization
Organization Name:CROSSROADS MEDICAL CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PILAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-627-3700
Mailing Address - Street 1:PO BOX 12514
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-2514
Mailing Address - Country:US
Mailing Address - Phone:318-627-3700
Mailing Address - Fax:318-627-3545
Practice Address - Street 1:340 WEBB SMITH DR
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:LA
Practice Address - Zip Code:71417-1910
Practice Address - Country:US
Practice Address - Phone:318-627-3700
Practice Address - Fax:318-627-3545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022337207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1446190Medicaid
LA1446190Medicaid