CROSSROADS HEALTH & COSMETIC CENTER PC - NPI 1700259173

Q: What is Crossroads Health & Cosmetic Center PC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

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About Crossroads Health & Cosmetic Center Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CROSSROADS HEALTH & COSMETIC CENTER PC (NPI 1700259173) is a healthcare organization registered as a nurse practitioner in Goshen, Indiana and active in the NPI registry since November 2015. The organization holds a CLIA Waiver certificate valid through September 24, 2027 and lists Joanna Roth, Nurse Practitioner, as its authorized official.

NPPES Registry Identity

NPI1700259173

Entity TypeOrganization

Primary Taxonomy363L00000X

Legal Business NameCROSSROADS HEALTH & COSMETIC CENTER PC

Location Address21764 OMEGA CTGoshen, IN 46528-7809

Mailing Address21764 Omega CtGoshen, IN 46528-7809 · (574) 891-4920 · Fax (574) 891-4902

Phone(574) 891-4920

Fax(574) 891-4902

Organization SubpartNo

Authorized OfficialJoanna RothNurse Practitioner · (574) 891-4920

Enumeration DateNovember 7, 2015

Last NPPES UpdateSeptember 9, 2019

✔ NPI 1700259173 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in IN · 71002933A

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Also ListedNurse Practitioner · Acute CareTaxonomy 363LA2100X · License 71002933A (IN)

Also ListedNurse Practitioner · Primary CareTaxonomy 363LP2300X · License 71002933A (IN)

21764 OMEGA CT, Goshen, IN 46528

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D2137338

Crossroads Health & Cosmetic Center PC · Goshen, IN

Active · expires Sep 24, 2027

CLIA Number15D2137338

Laboratory TypeIndependent

Certificate Effective DateSeptember 25, 2025

Certificate Expiration DateSeptember 24, 2027

Laboratory DirectorJoanna B. Roth

Laboratory Phone(574) 612-8016

Laboratory LocationCrossroads Health & Cosmetic Center PC21764 Omega Ct, Goshen, IN 46528

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOANNA BELLE ROTH M.S., A.C.N.P.-B.C.

Nurse Practitioner