Provider Demographics
NPI:1972267219
Name:CROSSROADS MEDICAL STAFFING LLC
Entity Type:Organization
Organization Name:CROSSROADS MEDICAL STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:HIGDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, MBA
Authorized Official - Phone:336-860-1476
Mailing Address - Street 1:804 LEE ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3143
Mailing Address - Country:US
Mailing Address - Phone:336-860-1476
Mailing Address - Fax:
Practice Address - Street 1:615 SAINT GEORGE SQUARE CT STE 300
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1368
Practice Address - Country:US
Practice Address - Phone:336-860-1476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROSSROADS MEDICAL STAFFING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory