{
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"EIN": null,
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"OrgName": "SOUTHEAST MISSOURI HEALTH NETWORK",
"LastName": null,
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"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6738 STATE HIGHWAY 77",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BENTON",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63736-8238",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "573-313-2500",
"MailingAddressFaxNumber": "573-313-2505",
"FirstLinePracticeLocationAddress": "CARUTHERSVILLE MEDICAL CENTER",
"SecondLinePracticeLocationAddress": "109 EAST 5TH STREET",
"PracticeLocationAddressCityName": "CARUTHERSVILLE",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63830-1417",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "573-359-9803",
"PracticeLocationAddressFaxNumber": "573-359-0990",
"EnumerationDate": "03/28/2014",
"LastUpdateDate": "05/22/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DEANE",
"AuthorizedOfficialFirstName": "SARAH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CHIEF FINANCIAL OFFICER",
"AuthorizedOfficialNamePrefix": "MS.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "573-313-2500",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QF0400X",
"TaxonomyName": "Federally Qualified Health Center (FQHC)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}