Organization
CROSS TRAILS MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKI A SMITH (CEO)
(573) 339-1196
Entity
Organization
Contact information
Practice address
408 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5725
(573) 332-0808
(573) 339-7945
Mailing address
408 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5725
(573) 332-0808
(573) 339-7945
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
508082807
—
MO
Enumeration date
05/17/2006
Last updated
06/26/2008
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