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General NPI Number Information
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NPI Number | 1932139169
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Entity Type | Organization
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Legal Business Name | CROSSROADS HEALTH CLINIC, P.A.
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 05/10/2012
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Provider Practice Location Address
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Address Line | 1801 S HARPER RD STE 7
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City | CORINTH
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State | MS
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Zip | 38834-6726
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Country | US
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Telephone | 662-286-2300
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Fax | 662-286-7010
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Provider Business Mailing Address
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Address Line | 1801 S HARPER RD STE 7
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City | CORINTH
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State | MS
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Zip | 38834-6726
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Country | US
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Telephone | 662-286-2300
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Fax | 662-286-7010
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DEBORA MCFALLS
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Credential | CFNP
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Telephone | 662-286-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 258980
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License Number State | MS
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