Healthcare Provider Details

I. General information

NPI: 1659834075
Provider Name (Legal Business Name): CROSSROADS SAINT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 SHADOW LN STE 120
LAS VEGAS NV
89102-2342
US

IV. Provider business mailing address

1120 SHADOW LN STE 120
LAS VEGAS NV
89102-2342
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-7746
  • Fax: 702-508-0757
Mailing address:
  • Phone: 702-382-7746
  • Fax: 702-508-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MORSS
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 702-382-7746