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
MONA WELLS (CFO)
(573) 339-1196
Entity
Organization
Contact information
Practice address
109 HWY 51 NORTH, MARBLE HILL, MO 63764
(573) 238-2725
(573) 238-3795
Mailing address
PO BOX 349, MARBLE HILL, MO 63764-0349
(573) 238-2725
(573) 238-3795
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
508082815
—
MO
01
—
CD9626
RAILROAD MEDICARE
MO
Enumeration date
12/18/2006
Last updated
03/18/2014
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