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14D1009257 CLIA NUMBER - CROSSROADS INTERNAL MEDICINE DEACONESS ILLINOIS CROSSROADS, INC

Laboratory Demographics

CLIA Number: 14D1009257

Facility Name: CROSSROADS INTERNAL MEDICINE DEACONESS ILLINOIS CROSSROADS, INC

Facility Address:
4101 N WATER TOWER PLACE
MOUNT VERNON, IL
ZIP 62864
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Facility Phone Number: 618 244-6222

Facility Type: Rural Health Clinic

Certificate Type: Waiver
NPI Number: 1790779874

Taxonomy: 207R00000X - Internal Medicine
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

CLIA Record

Field Name Field Value
CLIA Number 14D1009257
LAB Type Rural Health Clinic
Facility Name CROSSROADS INTERNAL MEDICINE DEACONESS ILLINOIS CROSSROADS, INC
Street 4101 N WATER TOWER PLACE
City MOUNT VERNON
State IL
ZIP 62864
Phone 618 244-6222
CertificateType 4
CertificateEffectiveDate 2/11/2023
CertificateExpirationDate 2/10/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024