MEDICARE: CROSSROADS SAINT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1659834075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS SAINT LLC

Provider Business Mailing Address
First Line	:	1120 SHADOW LN STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2342
Country	:	US
Telephone Number	:	702-382-7746
Fax Number	:	702-508-0757

Provider Business Practice Location Address
First Line	:	1120 SHADOW LN STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2342
Country	:	US
Telephone Number	:	702-382-7746
Fax Number	:	702-508-0757

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	JENNIFER MORSS
Credential	:
Telephone Number	:	702-382-7746

Provider Enumeration Date	:	04/11/2019
Last Update Date	:	04/11/2019

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Directions to “CROSSROADS SAINT LLC ” Practice Location

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