CROSS TRAILS MEDICAL CENTER (NPI# 1215368402) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215368402 |
| Entity Type | Organization |
| Organization Name | CROSS TRAILS MEDICAL CENTER |
| Practice Address |
1314 Brenda Ave Perryville MO 63775-2624 |
| Practice Telephone | 5733320808 |
| Practice Fax Number | 5733397945 |
| Mailing Telephone | 5733320808 |
| Mailing Fax Number | 5733397945 |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2013-12-12 |
| Authorized Official Name | MONA WELLS (CFO) |
| Authorized Official Telephone | 5733391196 |
| Is Organization Subpart | Y |
| Parent Organization Name | CROSS TRAILS MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225191752 | Cross Trails Medical Center | Clinic/Center | 307 Gabriel St., Advance, MO 63730 | 2006-12-18 |
| 1962565499 | Cross Trails Medical Center | Clinic/Center | 109 Hwy 51 North, Marble Hill, MO 63764 | 2006-12-18 |
| 1972925444 | Cross Trails Medical Center | Dentist | 1314 Brenda Ave, Perryville, MO 63775-2624 | 2014-01-17 |
| 1841508264 | Cross Trails Medical Center | Dentist | 307 Gabriel St, Advance, MO 63730 | 2010-09-20 |
| 1811051642 | Cross Trails Medical Center | Clinic/Center | 408 S Broadview St, Cape Girardeau, MO 63703-5725 | 2006-12-19 |
| 1821151622 | Cross Trails Medical Center | Clinic/Center | 109 Hwy 51 North, Marble Hill, MO 63764 | 2006-12-19 |
| 1356393268 | Cross Trails Medical Center | Clinic/Center | 408 S Broadview St, Cape Girardeau, MO 63703-5725 | 2006-05-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CROSS TRAILS MEDICAL CENTER | 408 S Broadview St, Cape Girardeau, MO 63703-5725 |
| Street Address |
1314 BRENDA AVE |
| City | PERRYVILLE |
| State | MO |
| Zip Code | 63775-2624 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508972233 | Patrick O'hara | Family Medicine | 1314 Brenda Ave, Perryville, MO 63775-2303 | 2006-08-23 |
| 1598316564 | Angela Kay Wright | Nurse Practitioner | 1314 Brenda Ave, Perryville, MO 63775-2303 | 2019-09-21 |
| 1568942902 | Julia L Abernathy | Dental Hygienist | 1314 Brenda Ave, Perryville, MO 63775-2303 | 2018-08-15 |
| 1205245685 | Diane Ko | Dentist | 1314 Brenda Ave, Perryville, MO 63775-2303 | 2014-08-11 |
| 1972925444 | Cross Trails Medical Center | Dentist | 1314 Brenda Ave, Perryville, MO 63775-2624 | 2014-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144949 | New Life Mission Inn - Missouri | Clinic/Center | 114 W. South, Perryville, MO 63775 | 2020-11-02 |
| 1881211829 | Sarah Jo Cross | Social Worker | 406 S Spring St, Ste 2, Perryville, MO 63775 | 2020-06-25 |
| 1902461908 | Health Care Pharmacy of Perryville, LLC | Pharmacy | 628 N Old St Marys Rd, Perryville, MO 63775 | 2019-05-06 |
| 1710437603 | Danielle Renee Hoeckele | Chiropractor | 1516 Edgemont Blvd Ste 100, Perryville, MO 63775 | 2016-10-04 |
| 1487024956 | Sherry Ann Goshen | Social Worker | 12 N Kings Hwy, Perryville, MO 63775 | 2015-09-28 |
| 1669801353 | Derek Adelman | Physical Therapy Assistant | 206 Hospital Lane, Ste 100, Perryville, MO 63775 | 2013-11-04 |
| 1407158678 | Perry County Memorial Hospital | Ambulance | 434 N West Street, Perryville, MO 63775 | 2010-11-22 |
| 1699928358 | East Missouri Action Agency, Inc. | Clinic/Center | 519 Old St Mary's Rd, Perryville, MO 63775 | 2008-10-28 |
| 1013171115 | Air Evac Ems Inc. | Ambulance | 4801 N Highway 51, Perryville, MO 63775 | 2008-07-17 |
| 1245457241 | Robert Schremp | Physical Therapist | 150 S. Mount Auburn Road, Cape Girardeau, MO 63775 | 2007-04-19 |
| Find all providers in zip 63775 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861932089 | West Cecil Health Center Inc. | Clinic/Center | 4863 Pulaski Hwy Ste 200, Perryville, MD 21903-1624 | 2017-03-07 |
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|---|---|---|---|---|
| 1952909079 | Northwest Health Services Inc | Clinic/Center | 202 S East St, Albany, MO 64402-1836 | 2020-10-12 |
| 1912505041 | Northwest Health Services Inc | Clinic/Center | 10500 State Route T, Savannah, MO 64485-2456 | 2020-10-12 |
| 1407469570 | Family Care Health Centers | Clinic/Center | 2717 Sidney Street, St. Louis, MO 63104 | 2020-08-28 |
| 1407478399 | Big Springs Medical Association | Clinic/Center | 2879 James Blvd, Poplar Bluff, MO 63901-3395 | 2020-05-13 |
| 1295356731 | Health Care Coalition of Lafayette County | Clinic/Center | 811 S Business Highway 13, Lexington, MO 64067-1515 | 2020-05-06 |
| 1376164699 | East Central Missouri Behavioral Health Services, Inc | Clinic/Center | 896 S Sturgeon St, Montgomery City, MO 63361-2716 | 2020-04-27 |
| 1750912044 | Northwest Health Services, Inc. | Clinic/Center | 418 E 2nd St, Maryville, MO 64468-1703 | 2020-01-27 |
| 1669003950 | Northwest Health Services, Inc. | Clinic/Center | 525 W South Hills Dr, Maryville, MO 64468-3653 | 2020-01-27 |
| 1063052553 | Compass Health, Inc. | Clinic/Center | 1319 E Highway 24 Ste B, Moberly, MO 65270-3682 | 2020-01-13 |
| 1407490741 | Advocates for A Healthy Community Inc | Clinic/Center | 2238 W Kingsley St, Springfield, MO 65807-5456 | 2019-10-30 |
| Find all providers with the same taxonomy | ||||
| City | PERRYVILLE |
| Zip Code | 63775 |
Please comment or provide details below to improve the information on CROSS TRAILS MEDICAL CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.