Provider Demographics
NPI:1144550617
Name:CROSSROADS OBGYN AND WELLNESS PA
Entity type:Organization
Organization Name:CROSSROADS OBGYN AND WELLNESS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KOURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-415-0376
Mailing Address - Street 1:PO BOX 2689
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77588-2689
Mailing Address - Country:US
Mailing Address - Phone:832-415-0376
Mailing Address - Fax:281-741-2459
Practice Address - Street 1:2000 CRAWFORD ST STE 1100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9009
Practice Address - Country:US
Practice Address - Phone:832-415-0376
Practice Address - Fax:281-741-2459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9657207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty