Healthcare Provider Details

I. General information

NPI: 1740540772
Provider Name (Legal Business Name): CROSSROADS URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10644 CONCORD ROAD
BRENTWOOD TN
37027-8811
US

IV. Provider business mailing address

30 BURTON HILLS BOULEVARD
NASHVILLE TN
37215-6183
US

V. Phone/Fax

Practice location:
  • Phone: 615-941-8768
  • Fax: 615-941-8789
Mailing address:
  • Phone: 615-988-2000
  • Fax: 615-891-1668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GAIL BERRY
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential: CPC
Phone: 615-988-2012