Healthcare Provider Details

I. General information

NPI: 1518304369
Provider Name (Legal Business Name): SOUTHEAST MISSOURI HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 LINE STREET
NEW MADRID MO
63869
US

IV. Provider business mailing address

420 LINE STREET
NEW MADRID MO
63869
US

V. Phone/Fax

Practice location:
  • Phone: 573-748-7602
  • Fax: 573-748-2673
Mailing address:
  • Phone: 573-748-2404
  • Fax: 573-748-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CHERYL WHITE
Title or Position: CEO
Credential:
Phone: 573-748-2404