Healthcare Provider Details

I. General information

NPI: 1316956840
Provider Name (Legal Business Name): SEH OB GYN CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 DOCTORS PARK
CAPE GIRARDEAU MO
63703-4927
US

IV. Provider business mailing address

1701 LACEY ST
CAPE GIRARDEAU MO
63701-5230
US

V. Phone/Fax

Practice location:
  • Phone: 573-339-1101
  • Fax: 573-339-1737
Mailing address:
  • Phone: 573-331-6880
  • Fax: 573-331-6887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID L STRONG
Title or Position: VICE PRESIDENT, CFO
Credential:
Phone: 573-334-4822