CROSS TRAILS MEDICAL CENTER (NPI# 1225191752) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225191752 |
| Entity Type | Organization |
| Organization Name | CROSS TRAILS MEDICAL CENTER |
| Practice Address |
307 Gabriel St. Advance MO 63730 |
| Mailing Address |
Po Box 39 Advance MO 63730-0039 |
| Practice Telephone | 5737223034 |
| Practice Fax Number | 5737223244 |
| Mailing Telephone | 5737223034 |
| Mailing Fax Number | 5737223244 |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2010-10-15 |
| Authorized Official Name | MRS. 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 508082823 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1215368402 | Cross Trails Medical Center | Clinic/Center | 1314 Brenda Ave, Perryville, MO 63775-2624 | 2013-12-12 |
| 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 |
307 GABRIEL ST. |
| City | ADVANCE |
| State | MO |
| Zip Code | 63730 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689292302 | Kimberly Backfisch | Counselor | 105b N Oak St, Advance, MO 63730 | 2020-07-09 |
| 1306272653 | Phelps In-home Care, LLC | In Home Supportive Care | 201 W. Sturdivant St., Advance, MO 63730 | 2013-09-18 |
| 1265691869 | Advance Medical Clinic | Clinic/Center | 103 South Oak Street, Advance, MO 63730 | 2008-06-09 |
| 1063620565 | Jerrilyn D Adkisson | Point of Service | 24777 State Hwy 25, Advance, MO 63730 | 2007-05-18 |
| 1063553402 | Advance R-iv Public Schools | Local Education Agency (LEA) | 19805 State Hwy C, Advance, MO 63730 | 2007-02-09 |
| 1154476919 | Cindy Beussink | Speech-Language Pathologist | 19134 County Rd 208, Advance, MO 63730 | 2007-01-24 |
| 1346356177 | Haven Health Cares | Clinic/Center | 502 West Sturdivant Street, Advance, MO 63730 | 2006-08-22 |
| 1841508264 | Cross Trails Medical Center | Dentist | 307 Gabriel St, Advance, MO 63730 | 2010-09-20 |
| 1326242645 | Mary Diane Reeves | Speech-Language Pathologist | 19805 State Hwy C, Box 370, Advance, MO 63730 | 2007-06-12 |
| 1154583987 | John Carl Graf IIi | Dentist | 307 Gabriel St, Advance, MO 63730-0039 | 2008-07-02 |
| Find all providers in zip 63730 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 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 | ||||
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| 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.