Provider Demographics
NPI:1053117598
Name:CROSSROADS CLINIC VOLUNTEERS IN MEDICINE
Entity type:Organization
Organization Name:CROSSROADS CLINIC VOLUNTEERS IN MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAIMUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-561-3133
Mailing Address - Street 1:10890 VETERANS MEMORIAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LAKE ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367
Mailing Address - Country:US
Mailing Address - Phone:636-561-3133
Mailing Address - Fax:636-625-3534
Practice Address - Street 1:10890 VETERANS MEMORIAL PARKWAY
Practice Address - Street 2:
Practice Address - City:LAKE ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367
Practice Address - Country:US
Practice Address - Phone:636-561-3133
Practice Address - Fax:636-625-3534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty