SOUTHEAST MISSOURI HEALTH NETWORK (NPI# 1013229749) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013229749 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST MISSOURI HEALTH NETWORK |
| Other Organization Name | OTTO BEAN DENTAL CLINIC |
| Practice Address |
500 Russell St Kennett MO 63857-2102 |
| Mailing Address |
420 Semo Dr P.o. Box 400 New Madrid MO 63869-1734 |
| Practice Telephone | 5738883000 |
| Practice Fax Number | 5738883003 |
| Mailing Telephone | 5737482404 |
| Mailing Fax Number | 5737488929 |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2014-08-06 |
| Authorized Official Name | CHRIS JONES (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 5737482404 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities | ||
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 1013229749 | 05 |
| Other Name | Type Code |
|---|---|
| otto bean dental clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619513215 | Southeast Missouri Health Network | Clinic/Center | 835 W Murray Ln, Sikeston, MO 63801-4056 | 2019-11-19 |
| 1790257228 | Southeast Missouri Health Network | Physician Assistant | Kennett Middle School Clinic, 510 College Ave, Kennett, MO 63857-2062 | 2018-12-21 |
| 1679019491 | Southeast Missouri Health Network | Dentist | 111 Prairie Drive, East Prairie, MO 63845 | 2017-01-18 |
| 1649697566 | Southeast Missouri Health Network | Clinic/Center | Caruthersville Medical Center, 109 East 5th Street, Caruthersville, MO 63830-1417 | 2014-03-28 |
| 1528348778 | Southeast Missouri Health Network | Dentist | 6724 Highway 77 E, Benton, MO 63736 | 2011-08-19 |
| 1598069247 | Southeast Missouri Health Network | Dentist | 420 Semo Dr, New Madrid, MO 63869-1734 | 2011-01-10 |
| 1194945154 | Southeast Missouri Health Network | Clinic/Center | 741 S Walnut St, Bernie, MO 63822-8900 | 2007-05-01 |
| 1720209794 | Southeast Missouri Health Network | Clinic/Center | 700 N Douglass St, Malden, MO 63863-1510 | 2007-05-01 |
| 1609095975 | Southeast Missouri Health Network | Clinic/Center | 421 Semo Dr, New Madrid, MO 63869-1733 | 2007-04-25 |
| 1932108974 | Southeast Missouri Health Network | Clinic/Center | 6738 State Highway 77, Benton, MO 63736-8238 | 2005-07-20 |
| Street Address |
500 RUSSELL ST |
| City | KENNETT |
| State | MO |
| Zip Code | 63857-2102 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467946434 | Panagiota Sandoval | Dentist | 500 Russell St, Kennett, MO 63857-2102 | 2018-06-21 |
| 1588158554 | Andrew Audel Sandoval | Dentist | 500 Russell St, Kennett, MO 63857-2102 | 2018-06-21 |
| 1639591506 | Delayna Michele Hunter | Registered Nurse | 500 Russell St, Kennett, MO 63857-2102 | 2014-01-13 |
| 1285996470 | Tina L Carter | Social Worker | 500 Russell St, Kennett, MO 63857-2102 | 2012-06-13 |
| 1710108766 | Southeast Missouri Health Network | Clinic/Center | 500 Russell St, Kennett, MO 63857-2102 | 2007-05-01 |
| 1619088390 | Judith Haggard | Nurse Practitioner | 500 Russell St, Kennett, MO 63857-2102 | 2006-08-31 |
| 1821013400 | Valerie A Smith | Family Medicine | 500 Russell St, Kennett, MO 63857-2102 | 2006-07-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992278139 | Fancilla Adams | Counselor | 925 State Highway V V, Kennett, MO 63857 | 2019-01-10 |
| 1962994418 | Kiana Alexis Brown | Behavior Technician | 925 Highway W, Kennett, MO 63857 | 2018-05-31 |
| 1568953636 | Doctors Health Group, Inc | Family Medicine | 1312 First Street, Kennett, MO 63857 | 2018-05-24 |
| 1003328873 | Ann Graf | Counselor | 925 Vv, Kennett, MO 63857 | 2017-11-01 |
| 1457872160 | Jessica Luster | Technician, Other | 1109 Jones St., Kennett, MO 63857 | 2017-07-03 |
| 1235669128 | Chandra Celeste Perkins-shannon | Case Manager/Care Coordinator | 925 Hwy V, Kennett, MO 63857 | 2017-06-14 |
| 1467991612 | Sarah Lobdell | Case Manager/Care Coordinator | 925 State Highway Vv, Kennett, MO 63857 | 2017-02-21 |
| 1881132900 | Brandy Rios | Community Health Worker | 935 State Hwy Vv, Kennett, MO 63857 | 2017-02-09 |
| 1295272060 | Johnny Marie Johnson | Case Manager/Care Coordinator | 925 Hwy Vv Family Counseling Center, Kennett, MO 63857 | 2017-01-31 |
| 1043756364 | Heather Bowman | Case Manager/Care Coordinator | 875 Hwy Vv, Kennett, MO 63857 | 2017-01-10 |
| Find all providers in zip 63857 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538217732 | L. Thomas Kelley | Dentist | 103 N Vandeventer St, Kennett, MO 63857-1933 | 2007-01-06 |
| 1982633699 | Burcham Dental Arts Clinic | Dentist | 205 Teaco Rd, Kennett, MO 63857-3236 | 2006-07-03 |
| 1366797953 | Higginbotham Dental Group, Pllc | Dentist | 103 1st St, Kennett, MO 63857-2051 | 2012-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194322990 | Wildhorse Dental Care, LLC | Dentist | 399 Patriotic Trl, Weldon Spring, MO 63304-7936 | 2020-10-05 |
| 1801493762 | Alexander Ahmadi | Dentist | 4171 Crescent Dr Ste 102, Saint Louis, MO 63129-3645 | 2020-10-05 |
| 1184239832 | Adam Wesley Gadbois | Dentist | 220 Diego Dr, Columbia, MO 65203-4919 | 2020-09-10 |
| 1568076701 | Alternative Sleep Solution | Dentist | 2700 Kanell Blvd., Poplar Bluff, MO 63901 | 2020-09-04 |
| 1538778592 | Maya Grace Habibi | Dentist | 5212 N Service Rd, Saint Peters, MO 63376-3950 | 2020-07-27 |
| 1427667500 | Breakthrough Dental Partners LLC | Dentist | 401 E Mechanic St, Harrisonville, MO 64701-2427 | 2020-07-24 |
| 1396353876 | Michael Rehme Jr. | Dentist | 2821 N Ballas Rd Ste 245, Saint Louis, MO 63131-2378 | 2020-07-21 |
| 1790303774 | Wed Khizirpour | Dentist | 1680 Nw Chipman Rd, Lees Summit, MO 64081-3934 | 2020-07-07 |
| 1275150716 | Hills Dentistry LLC | Dentist | 2000 Kentucky Ave Ste C, Platte City, MO 64079-7714 | 2020-07-01 |
| 1134745227 | Kayla White | Dentist | 1401 Forum Blvd Ste 203, Columbia, MO 65203-1915 | 2020-06-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.