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NPI Code Detail

MEDICARE: LACROIX MEDICAL CENTER

MEDICARE: LACROIX MEDICAL CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianR2H52MO

General Provider Information

NPI Number : 1912023441
Entity Type Code : Organization
Provider Name (Legal Business Name) : LACROIX MEDICAL CENTER
Provider Business Mailing Address
First Line : 3095 LEXINGTON AVE
Second Line : SUITE 200
City : CAPE GIRARDEAU
State : MO
Zip : 63701-2602
Country : US
Telephone Number : 573-339-0004
Fax Number :
Provider Business Practice Location Address
First Line : 3095 LEXINGTON AVE
Second Line : SUITE 200
City : CAPE GIRARDEAU
State : MO
Zip : 63701-2602
Country : US
Telephone Number : 573-339-0004
Fax Number : 573-335-9974
Authorized Official
Title or Position : DOCTOR
Name : DR. RODERIC CLAYTON CRIST
Credential : MD
Telephone Number : 573-339-0004
Provider Enumeration Date : 03/22/2007
Last Update Date : 06/28/2012

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Directions to “LACROIX MEDICAL CENTER ” Practice Location

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