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General NPI Number Information
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NPI Number | 1710047618
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Entity Type | Organization
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Legal Business Name | SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 1300 N ONE MILE RD SUITE 2
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City | DEXTER
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State | MO
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Zip | 63841-1042
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Country | US
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Telephone | 573-624-7662
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 368
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City | DEXTER
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State | MO
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Zip | 63841-0368
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Country | US
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Telephone | 573-624-3165
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Fax | 573-624-3157
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Authorized Official
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Title or Position | VICE PRESIDENT REGIONAL OPERATIONS
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Name | PAULA E HARRIS
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Credential |
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Telephone | 573-778-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | MO
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