Provider Demographics
NPI:1699050658
Name:SOUTHEAST MISSOURI HEALTH NETWORK
Entity type:Organization
Organization Name:SOUTHEAST MISSOURI HEALTH NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-748-2404
Mailing Address - Street 1:420 SEMO DR
Mailing Address - Street 2:P O BOX 400
Mailing Address - City:NEW MADRID
Mailing Address - State:MO
Mailing Address - Zip Code:63869-1734
Mailing Address - Country:US
Mailing Address - Phone:573-748-2404
Mailing Address - Fax:573-748-8929
Practice Address - Street 1:102 NORTH MARKET STREET
Practice Address - Street 2:
Practice Address - City:SENATH
Practice Address - State:MO
Practice Address - Zip Code:63876
Practice Address - Country:US
Practice Address - Phone:573-748-2440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)