Basic Information
| Provider Information | |||||||||
| NPI: | 1780984823 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CROSSROADS OBGYN, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5882 S HOSPITAL DR | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | GLOBE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 855019455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284258489 | ||||||||
| FaxNumber: | 9284258706 | ||||||||
| Practice Location | |||||||||
| Address1: | 5882 S HOSPITAL DR | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | GLOBE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 855019455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284258489 | ||||||||
| FaxNumber: | 9284258706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2010 | ||||||||
| LastUpdateDate: | 10/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | TRIPLETT | ||||||||
| AuthorizedOfficialFirstName: | STEPHENS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9284258489 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | OTC - PENDING | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.