SOUTHEASTHEALTH HOSPITAL HOLDINGS, LLC (NPI# 1053659904) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053659904 |
| Entity Type | Organization |
| Organization Name | SOUTHEASTHEALTH HOSPITAL HOLDINGS, LLC |
| Other Organization Name | SOUTHEASTHEALTH |
| Practice Address |
2002 Kanell Blvd Poplar Bluff MO 63901-4045 |
| Mailing Address |
Po Box 989 Poplar Bluff MO 63902-0989 |
| Practice Telephone | 5737780020 |
| Practice Fax Number | 5737767548 |
| Mailing Telephone | 5737780020 |
| Mailing Fax Number | 5737767548 |
| Enumeration Date | 2013-01-28 |
| Last Update Date | 2013-03-04 |
| Authorized Official Name | PAULA E HARRIS (VP REGIONAL OPERATIONS) |
| Authorized Official Telephone | 5737780020 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
Podiatric Medicine & Surgery Service Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| SOUTHEASTHEALTH | Doing Business As Name - Organization |
| Street Address |
2002 KANELL BLVD |
| City | POPLAR BLUFF |
| State | MO |
| Zip Code | 63901-4045 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679576300 | Robert C Young | Obstetrics & Gynecology | 2002 Kanell Blvd, Ste 205, Poplar Bluff, MO 63901-4046 | 2005-05-27 |
| 1396189767 | Southeast Health Pharmacy LLC | Pharmacy | 2002 Kanell Blvd, Ste 102, Poplar Bluff, MO 63901-4045 | 2013-04-29 |
| 1780927871 | Southeast Health Center of Stoddard County, LLC | Clinic/Center | 2002 Kanell Blvd, Poplar Bluff, MO 63901-4045 | 2013-03-27 |
| 1528336294 | Gary Luther Ward II | Family Medicine | 2002 Kanell Blvd, Suite 106, Poplar Bluff, MO 63901-4045 | 2011-12-08 |
| 1578617189 | Roger Richey | Nurse Practitioner | 2002 Kanell Blvd, Poplar Bluff, MO 63901-4045 | 2007-01-22 |
| 1124195391 | Advanced Healthcare Management Services, LLC | Clinic/Center | 2002 Kanell Blvd, Suite 101, Poplar Bluff, MO 63901-4042 | 2006-11-30 |
| 1659458198 | Jovito Pagkalinawan | Family Medicine | 2002 Kanell Blvd, Poplar Bluff, MO 63901-4045 | 2006-11-01 |
| 1295748465 | Robert C Young | Obstetrics & Gynecology | 2002 Kanell Blvd, Poplar Bluff, MO 63901-4042 | 2006-08-15 |
| 1306802632 | Advanced Health Care Management Services, LLC | Clinic/Center | 2002 Kanell Blvd, Poplar Bluff, MO 63901-4045 | 2006-04-25 |
| 1740246057 | Jimmy D Dachs | Counselor | 2002 Kanell Blvd, Suite 204, Poplar Bluff, MO 63901-4045 | 2006-04-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568076701 | Alternative Sleep Solution | Dentist | 2700 Kanell Blvd., Poplar Bluff, MO 63901 | 2020-09-04 |
| 1285271239 | Front Door Wellness LLC | Physical Therapist | Front Door Wellness LLC, 5835 Quail Meadows Drive, Poplar Bluff, MO 63901 | 2019-12-09 |
| 1104470368 | Andrew Akindutire | Dentist | 3101 Oak Groove Rd., Suite 6, Poplar Bluff, MO 63901 | 2019-07-26 |
| 1780195966 | Midwest Equipment Srv Systems LLC | Technician, Pathology | 2400 Lucy Lee Parkway, Suite C, Poplar Bluff, MO 63901 | 2017-10-16 |
| 1801259387 | Richard Justin Huber | Technician, Other | 3005 Warrior Ln, Poplar Bluff, MO 63901 | 2016-04-01 |
| 1699136275 | Donja Kirkland | Recreation Therapist | 1910a Greenwood Dr., Suite D, Poplar Bluff, MO 63901 | 2016-03-10 |
| 1760866867 | Bio-medical Applications of Missouri, Inc. | Clinic/Center | 3050 Tucker Road, Poplar Bluff, MO 63901 | 2015-07-17 |
| 1407246390 | Lisa Marie Payne | Physical Therapist | 4358c Highway Pp, Poplar Bluff, MO 63901 | 2015-01-29 |
| 1700202488 | Missouri Dental Professionals, Richard Straus, Dmd, PC | Dentist | 1602 W. Harper Street, Poplar Bluff, MO 63901 | 2014-03-05 |
| 1932521648 | Essential Family Healthcare, LLC | Clinic/Center | 1369 North Westwood Blvd., Poplar Bluff, MO 63901 | 2014-01-15 |
| Find all providers in zip 63901 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912121807 | Sharon K. Brandon, LLC | Family Medicine | 722 Maple Ridge Trl, Poplar Bluff, MO 63901-2216 | 2007-04-12 |
| 1538263827 | Cheryll Darline Rich | Family Medicine | 2002 Kanell Blvd Ste 103, Poplar Bluff, MO 63901-4042 | 2006-09-08 |
| 1568434520 | Austin R Tinsley | Family Medicine | 2400 Lucy Lee Pkwy, Ste A, Poplar Bluff, MO 63901 | 2006-02-03 |
| 1710965371 | Gilbert D Smith | Family Medicine | 225 Physicians Park, Suite 400, Poplar Bluff, MO 63901-3956 | 2006-01-04 |
| 1447256987 | Plunkett Family Care Center LLC | Family Medicine | 2480 Three Rivers Blvd, Poplar Bluff, MO 63901-2318 | 2005-06-21 |
| 1922003276 | Dorothy M Munch | Family Medicine | 930 N Westwood Blvd, Poplar Bluff, MO 63901-4242 | 2005-06-14 |
| 1538578075 | Mohamed Abdalaziz | Family Medicine | 3100 Oak Grove Rd, Poplar Bluff, MO 63901-1573 | 2014-08-08 |
| 1760898787 | Poplar Bluff Regional Medical Center, LLC | Family Medicine | 2588 N Westwood Blvd, Poplar Bluff, MO 63901-2339 | 2014-07-10 |
| 1760742084 | David William Wood | Family Medicine | 2360 Katy Ln, Poplar Bluff, MO 63901-2300 | 2012-05-21 |
| 1528336294 | Gary Luther Ward II | Family Medicine | 2002 Kanell Blvd, Suite 106, Poplar Bluff, MO 63901-4045 | 2011-12-08 |
| Find all providers in POPLAR BLUFF | ||||
| City | POPLAR BLUFF |
| Zip Code | 63901 |
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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.