Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Crossroads Physician Corp

Organization Internal Medicine Physician · NPI 1790779874

Crossroads Physician Corp is an Internal Medicine Physician in Mount Vernon, Illinois. Licensed in Illinois. Registered with an NPI since 2005.

Licensed in
IL
In the registry since
2005
Specialties on file
2
What do these letters mean?
Corp — Corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4101 N Water Tower Pl
Mount Vernon, IL 62864-6296
Phone: (618) 244-4313
Fax: (618) 244-9592
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X (IL)
Nurse Practitioner Taxonomy 363L00000X (IL)

Record details

NPI number1790779874
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationCrossroads Physician Corp
Authorized official Debbie Brewer — Director Of Provider Enrollment · (615) 465-7626
Other names Crossroads Internal Medicine #1
NPI enumeratedSeptember 6, 2005
Last updated in NPPESOctober 30, 2007
Mailing address4101 N Water Tower Pl, Mount Vernon, IL 62864-6296

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