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General NPI Number Information
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NPI Number | 1972267219
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Entity Type | Organization
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Legal Business Name | CROSSROADS MEDICAL STAFFING LLC
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Dates
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Enumeration Date | 10/22/2021
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 615 SAINT GEORGE SQUARE CT STE 300
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1368
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Country | US
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Telephone | 336-860-1476
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Fax |
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Provider Business Mailing Address
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Address Line | 804 LEE ST UNIT B
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City | KERNERSVILLE
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State | NC
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Zip | 27284-3143
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Country | US
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Telephone | 336-860-1476
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Fax |
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Authorized Official
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Title or Position | CEO/MANAGING MEMBER
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Name | TONYA LYNETTE HIGDON
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Credential | RN, MSN, MBA
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Telephone | 336-860-1476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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