Healthcare Provider Details

I. General information

NPI: 1366644361
Provider Name (Legal Business Name): CROSSROADS URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 MEMORIAL BLVD
MURFREESBORO TN
37129-5155
US

IV. Provider business mailing address

30 BURTON HILLS BLVD SUITE 175
NASHVILLE TN
37215-6140
US

V. Phone/Fax

Practice location:
  • Phone: 615-864-8713
  • Fax: 615-301-6550
Mailing address:
  • Phone: 615-988-2009
  • Fax: 615-250-9773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN REEL
Title or Position: CONTROLLER
Credential:
Phone: 615-864-8709