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Organization

CROSS TRAILS MEDICAL CENTER

Active
Parent organization
CROSS TRAILS MEDICAL CENTER
Organization subpart
Yes

Provider details

NPI number
Legal business name
CROSS TRAILS MEDICAL CENTER
Authorized official
MRS. MONA WELLS (CFO)
(573) 339-1196
Entity
Organization

Contact information

Practice address
307 GABRIEL ST., ADVANCE, MO 63730
(573) 722-3034
(573) 722-3244
Mailing address
PO BOX 39, ADVANCE, MO 63730-0039
(573) 722-3034
(573) 722-3244

Taxonomy

Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
508082823
MO
Enumeration date
12/18/2006
Last updated
10/15/2010
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