Healthcare Provider Details

I. General information

NPI: 1174523948
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: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PLUM ST
DONIPHAN MO
63935
US

IV. Provider business mailing address

109 PLUM STREET
DONIPHAN MO
63935
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number528-0
License Number StateMO

VIII. Authorized Official

Name: CHERYL BARTON
Title or Position: CEO
Credential: RN
Phone: 573-996-2141