Healthcare Provider Details

I. General information

NPI: 1023015468
Provider Name (Legal Business Name): SOUTHERN CROSS MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S SILVER SPRINGS RD STE A
CAPE GIRARDEAU MO
63703
US

IV. Provider business mailing address

PO BOX 326
CAPE GIRARDEAU MO
63702-0326
US

V. Phone/Fax

Practice location:
  • Phone: 573-339-7185
  • Fax: 573-339-1079
Mailing address:
  • Phone: 573-339-7185
  • Fax: 573-339-1079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number000060205
License Number StateMO

VIII. Authorized Official

Name: MS. MARY TERESA BAUER
Title or Position: SECRETARY/TREASURER
Credential:
Phone: 573-339-7185