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General NPI Number Information
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NPI Number | 1619513215
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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 | 11/19/2019
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 835 W MURRAY LN
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City | SIKESTON
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State | MO
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Zip | 63801-4056
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Country | US
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Telephone | 573-472-8808
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Fax |
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Provider Business Mailing Address
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Address Line | 6738 STATE HIGHWAY 77
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City | BENTON
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State | MO
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Zip | 63736-8238
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Country | US
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Telephone | 573-313-2500
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | SARA DEANE
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Credential | CFO
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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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