SOUTHEAST HEALTH CENTER OF STODDARD COUNTY LLC (NPI# 1265575385) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1265575385 |
Entity Type | Organization |
Organization Name | SOUTHEAST HEALTH CENTER OF STODDARD COUNTY LLC |
Other Organization Name | SOUTHEASTHEALTH BLOOMFIELD CLINIC |
Practice Address |
1003 State Hwy 25 North Bloomfield MO 63825 |
Mailing Address |
Po Box 368 Dexter MO 63841-0368 |
Practice Telephone | 5735683686 |
Mailing Telephone | 5736243165 |
Mailing Fax Number | 5736243157 |
Enumeration Date | 2007-02-15 |
Last Update Date | 2013-10-18 |
Authorized Official Name | PAULE E HARRIS (VICE PRESIDENT REGIONAL OPERATIONS) |
Authorized Official Telephone | 5737780020 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
MO | Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MO | 599176906 | 05 | |
MO | RAILROAD MEDICARE | DC5318 | 01 |
Other Name | Type Code |
---|---|
SoutheastHEALTH Bloomfield Clinic | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1639736457 | Southeast Health Center of Stoddard County LLC | Clinic/Center | 800 Us Highway 61, New Madrid, MO 63869-1106 | 2019-05-28 |
1477997567 | Southeast Health Center of Stoddard County LLC | Emergency Medicine | 1200 N One Mile Road, Dexter, MO 63841-1000 | 2013-04-19 |
1679041040 | Southeast Health Center of Stoddard County LLC | Clinic/Center | 522 Virginia St, Sikeston, MO 63801-5812 | 2018-11-05 |
1679820286 | Southeast Health Center of Stoddard County LLC | Clinic/Center | 810 N Walnut St, Bernie, MO 63822-8901 | 2012-08-14 |
1629111729 | Southeast Health Center of Stoddard County LLC | Clinic/Center | 1300 N One Mile Rd, Dexter, MO 63841-1042 | 2007-02-15 |
Street Address |
1003 STATE HWY 25 NORTH |
City | BLOOMFIELD |
State | MO |
Zip Code | 63825 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1073039715 | Susan L Shea | Counselor | 402 Barbara Street, Bloomfield, MO 63825 | 2017-08-15 |
1750571931 | Robin Denise Osborn | Counselor | 206 S Prairie Street, Bloomfield, MO 63825 | 2007-07-25 |
1588714992 | Bloomfield R-14 Schools | Local Education Agency (LEA) | 505 Court St., Bloomfield, MO 63825 | 2007-01-11 |
1326108226 | Dexter Hospital LLC | Internal Medicine | 1003 Highway 25 North, Bloomfield, MO 63825 | 2006-12-11 |
1245317700 | Amy Holland | Nurse Practitioner | 1003 Hwy 25 N, Bloomfield, MO 63825 | 2006-11-01 |
1225112345 | Town Pharmacy Inc. | Pharmacy | 700 Highway 25 South, Bloomfield, MO 63825 | 2006-10-25 |
1114015682 | Cecil Ray Vincent Sr. | Pharmacist | 302 S Prairie, Bloomfield, MO 63825 | 2006-10-10 |
1033182092 | Peter W Somers | Family Medicine | 101 South Prairie Street, Bloomfield, MO 63825 | 2006-02-09 |
1023424041 | Poplar Bluff Regional Medical Center, LLC | Family Medicine | 101 South Prairie Street, Bloomfield, MO 63825 | 2014-07-10 |
1528205788 | Robert Lee Joplin | Driver | 206 S Prairie Street, Bloomfield, MO 63825 | 2009-01-09 |
Find all providers in zip 63825 |
Taxonomy Code | 261QR1300X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Rural Health |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1174550115 | Poplar Bluff Regional Medical Center LLC | Clinic/Center | 101 S. Prairie, Bloomfield, MO 63825-0200 | 2006-06-26 |
1699753285 | Greene County Health Clinic, LLC | Clinic/Center | 12 W Main St, Bloomfield, IN 47424-1424 | 2006-01-04 |
1821413667 | Davis County Hospital | Clinic/Center | 509 N Madison St, Ste 100, Bloomfield, IA 52537-1271 | 2014-03-04 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1871102137 | Washington County Memorial Hospital | Clinic/Center | 14206 Hwy C, Belgrade, MO 63622 | 2020-07-23 |
1891325072 | Scotland County Memorial Hospital | Clinic/Center | 55682 State Highway 6 Ste A, Edina, MO 63537-4268 | 2020-01-16 |
1639736457 | Southeast Health Center of Stoddard County LLC | Clinic/Center | 800 Us Highway 61, New Madrid, MO 63869-1106 | 2019-05-28 |
1134633456 | Pike County Memorial Hospital | Clinic/Center | 1420 S Business 61 Unit Fde, Bowling Green, MO 63334-5230 | 2017-11-22 |
1720505894 | Perry County Health System | Clinic/Center | 210 Hospital Ln Ste 202, Perryville, MO 63775-4200 | 2017-08-29 |
1427572007 | Missouri Delta Medical Center | Clinic/Center | 209 W Yoakum Ave, Chaffee, MO 63740-1138 | 2017-07-26 |
1790213676 | Jackson Primary Care LLC | Clinic/Center | 2685 E Main St Ste A, Jackson, MO 63755-2474 | 2017-05-23 |
1972050581 | Sgoh Acquisition, Inc. | Clinic/Center | 912b State Highway 59, Goodman, MO 64843-8252 | 2016-09-01 |
1144605312 | Nevada City Hospital | Clinic/Center | 627 S Ash St Ste B, Nevada, MO 64772 | 2015-07-29 |
1669856829 | Ssm Regional Health Services | Clinic/Center | 2511 W Edgewood Dr Ste F, Jefferson City, MO 65109-5869 | 2015-07-16 |
Find all providers with the same taxonomy |
City | BLOOMFIELD |
Zip Code | 63825 |
Please comment or provide details below to improve the information on SOUTHEAST HEALTH CENTER OF STODDARD COUNTY LLC.
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.