Provider Demographics
NPI:1942540984
Name:CROSSROADS FAMILY MEDICINE
Entity Type:Organization
Organization Name:CROSSROADS FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:270-465-8133
Mailing Address - Street 1:150 W BEAR TRACK RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-8709
Mailing Address - Country:US
Mailing Address - Phone:270-465-8133
Mailing Address - Fax:270-789-1543
Practice Address - Street 1:150 W BEAR TRACK RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-8709
Practice Address - Country:US
Practice Address - Phone:270-465-8133
Practice Address - Fax:270-789-1543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY023202083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty