Organization Name: | CROSSROADS UROLOGY |
NPI Number: | 1508038977 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PEGGY LOUISE ST.JOHN (OFFICE MANAGER) |
Mailing Address: | 785 Ohio Ave Suite 1b Clarksdale |
State: | MS US |
Postal Code: | 386146217 |
Phone Number: | 6626211880 |
Fax Number: | 6626211882 |
NPI Enumeration Date: | 03/26/2008 |
NPI Last Update Date: | 03/26/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 20046 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |