Provider Demographics
NPI:1780984823
Name:CROSSROADS OBGYN, PC
Entity type:Organization
Organization Name:CROSSROADS OBGYN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHENS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-425-8489
Mailing Address - Street 1:5882 S HOSPITAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-9455
Mailing Address - Country:US
Mailing Address - Phone:928-425-8489
Mailing Address - Fax:928-425-8706
Practice Address - Street 1:5882 S HOSPITAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-9455
Practice Address - Country:US
Practice Address - Phone:928-425-8489
Practice Address - Fax:928-425-8706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC - PENDING261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health