Crossroads Physician Corp
Crossroads Physician Corp is a healthcare organization registered as Surgery Physician in Mount Vernon, IL, holding Type 2 (organization) NPI 1417941436 since 2005. The authorized official on file is Debbie Brewer, Director of Provider Enrollment.
✓ Active NPI ✓ Valid NPI checksum Organization subpart
| NPI | 1417941436 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Crossroads Physician Corp |
| Other name | <Unavail> |
| Parent organization | Crossroads Physician Corp |
| Practice address | 209 CROSSROADS PL, SUITE 130, Mount Vernon, IL, 62864 |
| Phone | 6182423831 |
| Fax | 6182423375 |
| Enumeration date | 2005-09-06 |
| Last updated in NPPES | 2007-10-30 |
Authorized official
| Name | Debbie Brewer |
|---|---|
| Title | Director of Provider Enrollment |
| Phone | 6154657626 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 208600000X | Surgery Physician | Primary | — | IL |
Copy-ready billing details
Provider: Crossroads Physician Corp NPI: 1417941436 Taxonomy: 208600000X (Surgery Physician) Address: 209 CROSSROADS PL, SUITE 130, Mount Vernon, IL, 62864
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1780678797 | Crossroads Physician Corp | Organization | Family Medicine Physician | Mount Vernon, IL |
| 1699769612 | Crossroads Physician Corp | Organization | Family Medicine Physician | Mount Vernon, IL |
| 1508850520 | Crossroads Physicians Corp | Organization | Family Medicine Physician | Mount Vernon, IL |
| 1417909060 | Gary Reagan | Individual | Urology Physician | Mount Vernon, IL |
| 1912959578 | Lawrence Hollander | Individual | Surgery Physician | Mount Vernon, IL |
| 1790725307 | Chirag Dave | Individual | Pulmonary Disease Physician | Mount Vernon, IL |
| 1801806039 | Elizabeth Cox | Individual | Family Medicine Physician | Mount Vernon, IL |
| 1194980516 | Crossroads Physician Corp | Organization | Family Medicine Physician | Mount Vernon, IL |
Verify this record
Cross-check NPI 1417941436 against the authoritative CMS record: view Crossroads Physician Corp on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is a Type 2 NPI?
What type of organization is Crossroads Physician Corp?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2007-10-30.