CROSS TRAILS MEDICAL CENTER (NPI# 1962565499) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962565499 |
| Entity Type | Organization |
| Organization Name | CROSS TRAILS MEDICAL CENTER |
| Practice Address |
109 Hwy 51 North Marble Hill MO 63764 |
| Mailing Address |
Po Box 349 Marble Hill MO 63764-0349 |
| Practice Telephone | 5732382725 |
| Practice Fax Number | 5732383795 |
| Mailing Telephone | 5732382725 |
| Mailing Fax Number | 5732383795 |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2014-03-18 |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | RAILROAD MEDICARE | CD9626 | 01 |
| MO | 508082815 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225191752 | Cross Trails Medical Center | Clinic/Center | 307 Gabriel St., Advance, MO 63730 | 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 |
109 HWY 51 NORTH |
| City | MARBLE HILL |
| State | MO |
| Zip Code | 63764 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730218827 | Joesph D Cravens | Dental Hygienist | 109 Hwy 51 North, Marble Hill, MO 63764 | 2007-03-05 |
| 1821151622 | Cross Trails Medical Center | Clinic/Center | 109 Hwy 51 North, Marble Hill, MO 63764 | 2006-12-19 |
| 1952464372 | Patricia Merkley | Dentist | 109 Hwy 51 North, Marble Hill, MO 63764 | 2006-12-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982201935 | J & J Assisted Living LLC | Assisted Living Facility | 104 Wesbecher Ln, Marble Hill, MO 63764 | 2020-10-02 |
| 1497310932 | Select Physical Therapy Holdings, Inc. | Clinic/Center | 201 Highway 34 West, Marble Hill, MO 63764 | 2019-05-09 |
| 1467950196 | Ronald Brand | Counselor | 103 El Nathan Drive, Marble Hill, MO 63764 | 2018-01-29 |
| 1053827964 | Dianas Boarding Home Inc | Community Based Residential Treatment Facility, Mental Illness | Hc 64, Box 4683, Marble Hill, MO 63764 | 2017-12-15 |
| 1699293274 | Alyssa Naschell Grado | Physical Therapist | 702-mo 34, Marble Hill, MO 63764 | 2017-09-05 |
| 1063969699 | Julie Elfrink | Registered Nurse | 107 N. Hwy 51, Marble Hill, MO 63764 | 2016-09-01 |
| 1194022921 | Suzanne Raye Matthews | Nurse Practitioner | 307 Broadway, Marble Hill, MO 63764 | 2011-02-14 |
| 1619281789 | Ryan Michael Sutterer | Optometrist | 503 W. Main Street, Marble Hill, MO 63764 | 2010-08-01 |
| 1215267976 | L. Mark Milde | Dentist | 101 First St., Marble Hill, MO 63764 | 2009-12-31 |
| 1194985739 | J & J Assistive Living | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 104 Wesbecher, Marble, MO 63764 | 2008-06-16 |
| Find all providers in zip 63764 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 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 | MARBLE HILL |
| Zip Code | 63764 |
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.