Provider Demographics
NPI:1871068361
Name:NORTHCROSS INTERNAL MEDICINE, PLLC
Entity type:Organization
Organization Name:NORTHCROSS INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:NORTHCROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-523-7781
Mailing Address - Street 1:3445 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4667
Mailing Address - Country:US
Mailing Address - Phone:901-523-7781
Mailing Address - Fax:901-523-7799
Practice Address - Street 1:3445 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4667
Practice Address - Country:US
Practice Address - Phone:901-523-7781
Practice Address - Fax:901-523-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care