Provider Demographics
NPI:1205252343
Name:CROSSWINDS PHYSICIAN SERVICES, INC
Entity type:Organization
Organization Name:CROSSWINDS PHYSICIAN SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:S
Authorized Official - Last Name:FREED
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-347-3400
Mailing Address - Street 1:1224 66TH ST NORTH
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710
Mailing Address - Country:US
Mailing Address - Phone:727-347-3400
Mailing Address - Fax:727-347-0502
Practice Address - Street 1:1224 66TH ST NORTH
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710
Practice Address - Country:US
Practice Address - Phone:727-347-3400
Practice Address - Fax:727-347-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty