CROSS TRAILS MEDICAL CENTER (NPI# 1356393268) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1356393268 |
Entity Type | Organization |
Organization Name | CROSS TRAILS MEDICAL CENTER |
Practice Address |
408 S Broadview St Cape Girardeau MO 63703-5725 |
Practice Telephone | 5733320808 |
Practice Fax Number | 5733397945 |
Mailing Telephone | 5733320808 |
Mailing Fax Number | 5733397945 |
Enumeration Date | 2006-05-17 |
Last Update Date | 2008-06-26 |
Authorized Official Name | VICKI A SMITH (CEO) |
Authorized Official Telephone | 5733391196 |
Is Organization Subpart | N |
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 | 508082807 | 05 |
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 |
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 |
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 |
408 S BROADVIEW ST |
City | CAPE GIRARDEAU |
State | MO |
Zip Code | 63703-5725 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1316948730 | Susan B Farrow | Nurse Practitioner | 408 S Broadview St, Cape Girardeau, MO 63703-5725 | 2005-08-09 |
1114563798 | Tracey D Cooley | Dental Hygienist | 408 S Broadview St, Cape Girardeau, MO 63703-5725 | 2019-11-19 |
1386108181 | Constance R Koerner-bean | Social Worker | 408 S Broadview St, Cape Girardeau, MO 63703-5725 | 2019-01-25 |
1356839971 | Andrew J Bova | Dentist | 408 S Broadview St, Cape Girardeau, MO 63703-5725 | 2018-04-30 |
1447754122 | Katie Kristine Berghoff | Dental Hygienist | 408 S Broadview St, Cape Girardeau, MO 63703-5725 | 2018-03-19 |
1104348507 | Mitra Nejat-bina | Dentist | 408 S Broadview St, Cape Girardeau, MO 63703-5725 | 2017-07-07 |
1609295674 | Autumn Rose Vangennip | Dental Hygienist | 408 S Broadview St, Cape Girardeau, MO 63703-5725 | 2014-04-07 |
1205178274 | Nancy K Johnson | Nurse Practitioner | 408 S Broadview St, Cape Girardeau, MO 63703-5725 | 2013-03-18 |
1083964563 | Ashley Lipke | Registered Nurse | 408 S Broadview St, Cape Girardeau, MO 63703-5725 | 2012-09-12 |
1669746624 | Alan David Jones | Dentist | 408 S Broadview St, Cape Girardeau, MO 63703-5725 | 2012-03-07 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720566102 | Christian Torres Diaz | Dentist | 3070 William Street, Cape Girardeau, MO 63703 | 2018-07-30 |
1457758153 | Broadway Ltc, LLC | Pharmacy | 37 Doctors Park Ste 7, Cape Girardeau, MO 63703 | 2014-11-24 |
1336562263 | Rachel Speer | Community Health Worker | 20 South Sprigg St, Cape Girardeau, MO 63703 | 2014-01-29 |
1245653120 | Mary Wilburn | Community Health Worker | 20 S Spigg, Cape Girardeau, MO 63703 | 2014-01-28 |
1831523695 | Saint Francis Medical Center | General Acute Care Hospital | 150 South Mount Auburn Road, Suite 342, Cape Girardeau, MO 63703 | 2013-08-29 |
1033481163 | J K Essmyer Medical Services LLC | Clinic/Center | 300 Mt Auburn Rd, Auburn Surgery Center, Inc, Cape Girardeau, MO 63703 | 2012-02-06 |
1477867844 | Drx - East Missouri Providers, P.C. | Family Medicine | 465 S Mount Auburn Road, Suite 103, Cape Girardeau, MO 63703 | 2010-07-28 |
1346564879 | Richard William Tobey | Family Medicine | 3250 Gordonville Rd Ste 301, Cape Girardeau, MO 63703 | 2010-03-26 |
1144413568 | Stephanie Danette Miller | Family Medicine | 817 S. Mount Auburn, Suite 100, Southeast Primary Care, Cape Gerardeau, MO 63703 | 2007-08-20 |
1437349305 | Shanaree Mae Muzinich | Radiology | 70 Doctor's Park, Cape Girardeau, MO 63703 | 2007-07-27 |
Find all providers in zip 63703 |
Taxonomy Code | 261QF0400X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Federally Qualified Health Center (FQHC) |
Definition to come... |
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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 | CAPE GIRARDEAU |
Zip Code | 63703 |
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.