MEDICARE: CROSSROADS MEDICAL CONSULTANTS 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	207R00000X	Internal Medicine Physician	022337	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710162128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS MEDICAL CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	PO BOX 12514
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71315-2514
Country	:	US
Telephone Number	:	318-627-3700
Fax Number	:	318-627-3545

Provider Business Practice Location Address
First Line	:	340 WEBB SMITH DR
Second Line	:
City	:	COLFAX
State	:	LA
Zip	:	71417-1910
Country	:	US
Telephone Number	:	318-627-3700
Fax Number	:	318-627-3545

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	JAY L PILAND
Credential	:	MD
Telephone Number	:	318-627-3700

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	01/03/2008

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