Healthcare Provider Details

I. General information

NPI: 1881694685
Provider Name (Legal Business Name): SOUTHEAST HEALTH CENTER OF RIPLEY COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 LEROUX DRIVE
DONIPHAN MO
63935-1277
US

IV. Provider business mailing address

109 PLUM ST
DONIPHAN MO
63935-1277
US

V. Phone/Fax

Practice location:
  • Phone: 573-996-2136
  • Fax: 573-996-3105
Mailing address:
  • Phone: 573-996-2141
  • Fax: 573-996-3949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHY HARP
Title or Position: BUSINESS OFFICE SUPERVISOR
Credential:
Phone: 573-996-2141