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General NPI Number Information
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NPI Number | 1598069247
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Entity Type | Organization
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Legal Business Name | SOUTHEAST MISSOURI HEALTH NETWORK
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 741 S WALNUT ST
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City | BERNIE
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State | MO
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Zip | 63822-8900
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Country | US
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Telephone | 573-293-6930
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Fax | 573-293-6841
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Provider Business Mailing Address
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Address Line | 741 SOUTH WALNUT
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City | BERNIE
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State | MO
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Zip | 63822
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Country | US
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Telephone | 573-293-6930
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Fax | 573-293-6841
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MS. SARA DEANE
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Credential |
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Telephone | 573-313-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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