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General NPI Number Information
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NPI Number | 1629186895
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Entity Type | Organization
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Legal Business Name | CROSSROADS NEUROSURGICAL ASSOCIATES, P.A.
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 2705 HOSPITAL DR SUITE 412
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City | VICTORIA
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State | TX
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Zip | 77901-5775
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Country | US
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Telephone | 361-827-0200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5311
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City | VICTORIA
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State | TX
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Zip | 77903-5311
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Country | US
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Telephone | 361-827-0200
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Fax |
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Authorized Official
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Title or Position | NEUROSURGEON
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Name | DR. KEITH ALLEN NORVILL
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Credential | D.O.
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Telephone | 361-827-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | J 3562
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License Number State | TX
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