Provider Demographics
NPI:1114755642
Name:CROSSROADS VIROLOGY LLC
Entity type:Organization
Organization Name:CROSSROADS VIROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:ASHLEIGH
Authorized Official - Last Name:BOEHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-571-7956
Mailing Address - Street 1:1403 VICTORIA STATION DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3092
Mailing Address - Country:US
Mailing Address - Phone:361-571-7956
Mailing Address - Fax:361-214-1460
Practice Address - Street 1:1403 VICTORIA STATION DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3092
Practice Address - Country:US
Practice Address - Phone:361-571-7956
Practice Address - Fax:361-214-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty