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General NPI Number Information
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NPI Number | 1063692515
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Entity Type | Organization
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Legal Business Name | CROSSROADS FAMILY MEDICAL CARE P.A.
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 11/10/2009
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Provider Practice Location Address
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Address Line | 3121 PLATEAU RD
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City | NEWTON
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State | NC
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Zip | 28658-8900
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Country | US
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Telephone | 704-276-9200
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Fax | 704-276-9300
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Provider Business Mailing Address
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Address Line | 3121 PLATEAU RD
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City | NEWTON
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State | NC
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Zip | 28658-8900
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Country | US
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Telephone | 704-276-9200
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Fax | 704-276-9300
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | BILL JACK PARKER
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Credential | M.D.
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Telephone | 704-276-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 38402
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License Number State | NC
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