Provider Demographics
NPI:1285050948
Name:SOUTHEAST HEALTH CENTER OF REYNOLDS COUNTY, LLC
Entity type:Organization
Organization Name:SOUTHEAST HEALTH CENTER OF REYNOLDS COUNTY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT REGIONAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-778-0020
Mailing Address - Street 1:100 HIGHWAY 21 N
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63638-9409
Mailing Address - Country:US
Mailing Address - Phone:573-663-2511
Mailing Address - Fax:573-663-2815
Practice Address - Street 1:100 HIGHWAY 21 N
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:MO
Practice Address - Zip Code:63638-9409
Practice Address - Country:US
Practice Address - Phone:573-663-2511
Practice Address - Fax:573-663-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care