SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC (NPI# 1457660045) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457660045 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC |
| Other Organization Name | THE CLINIC AT WALMART OPERATED BY SOUTHEASTHEALTH |
| Practice Address |
2025 W Business Us Highway 60 Dexter MO 63841-2879 |
| Mailing Address |
Po Box 368 Dexter MO 63841-0368 |
| Practice Telephone | 5736144600 |
| Practice Fax Number | 5736144606 |
| Mailing Telephone | 5736141951 |
| Mailing Fax Number | 5736243157 |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2015-08-26 |
| Authorized Official Name | ADAM BRACKS (CEO) |
| Authorized Official Telephone | 5736141900 |
| Is Organization Subpart | Y |
| Parent Organization Name | SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 1457660045 | 05 |
| Other Name | Type Code |
|---|---|
| The Clinic at Walmart operated by SoutheastHEALTH | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801891015 | Southeast Health Center of Stoddard County, LLC | Home Health | 1300 N One Mile Rd, Suite 7, Dexter, MO 63841-1042 | 2005-06-15 |
| 1780927871 | Southeast Health Center of Stoddard County, LLC | Clinic/Center | 2002 Kanell Blvd, Poplar Bluff, MO 63901-4045 | 2013-03-27 |
| 1316240096 | Southeast Health Center of Stoddard County, LLC | Clinic/Center | 500 N Douglass St, Malden, MO 63863-1506 | 2010-12-17 |
| 1386802023 | Southeast Health Center of Stoddard County, LLC | Medicare Defined Swing Bed Unit | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2008-05-29 |
| 1790828812 | Southeast Health Center of Stoddard County, LLC | Clinic/Center | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2007-02-15 |
| 1568524437 | Southeast Health Center of Stoddard County, LLC | Family Medicine | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2006-12-15 |
| 1710047618 | Southeast Health Center of Stoddard County, LLC | Clinic/Center | 1300 N One Mile Rd, Suite 2, Dexter, MO 63841-1042 | 2006-12-11 |
| 1801990825 | Southeast Health Center of Stoddard County, LLC | General Acute Care Hospital | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2006-09-11 |
| Street Address |
2025 W BUSINESS US HIGHWAY 60 |
| City | DEXTER |
| State | MO |
| Zip Code | 63841-2879 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487735577 | Wal-mart Stores East, Lp | Technician/Technologist | 2025 W Business Us Highway 60, Dexter, MO 63841-2879 | 2006-10-17 |
| 1811407422 | Derek Demaree | Pharmacist | 2025 W Business Us Highway 60, Dexter, MO 63841-2879 | 2017-10-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417558941 | Christa Renee Mcbroom | Pharmacist | 2025 Business Hwy 60w, Dexter, MO 63841 | 2020-11-02 |
| 1306230107 | David Mulcahy | Pharmacist | 904 West Business Hwy 60, Dexter, MO 63841 | 2015-03-19 |
| 1285038935 | Clearwater In-home Care, Inc. | Technician | 1525 Business Highway 60, Suite C, Dexter, MO 63841 | 2014-10-09 |
| 1720404064 | William Simmons | Pharmacist | 904 W Business Highway 60, Dexter, MO 63841 | 2014-03-11 |
| 1134498736 | Susan Caroline Jones | Physical Therapist | 913 West Business Hwy 60, Dexter, MO 63841 | 2011-12-28 |
| 1427350594 | Dexter Hospital LLC | Family Medicine | 2025 W Bus Hwy 60, Dexter, MO 63841 | 2010-11-23 |
| 1992028112 | Hilda Fuwell's Residential Care LLC | Clinic/Center | 900 South One Mile Road, Dexter, MO 63841 | 2010-03-02 |
| 1508197047 | Super D Drugs Acquisition Co | Durable Medical Equipment & Medical Supplies | 907 West Business Hwy. 60, Dexter, MO 63841 | 2010-01-22 |
| 1215262183 | Ozark Wellness & Athletic Club | Physical Therapist | 1521 W Bus. Hwy. 60, Dexter, MO 63841 | 2009-10-12 |
| 1225268618 | Practice Tee, LLC | Family Medicine | 1523 W Business Hwy 60, Dexter, MO 63841 | 2009-07-20 |
| Find all providers in zip 63841 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225161474 | Roswell Hospital Corporation | Clinic/Center | 116 East 2nd Street, Dexter, NM 88230 | 2007-03-14 |
| 1710923651 | The Lakeside Clinic | Clinic/Center | 38843 Dexter Rd, Dexter, OR 97431-9775 | 2006-06-21 |
| 1700821212 | Poplar Bluff Regional Medical Center LLC | Clinic/Center | 610 N One Mile Rd, Dexter, MO 63841-2539 | 2006-06-18 |
| 1104264068 | Peacehealth | Clinic/Center | 38843 Dexter Rd, Dexter, OR 97431-9600 | 2013-06-12 |
| 1760704878 | Peacehealth | Clinic/Center | 38843 Dexter Rd, Dexter, OR 97431-0110 | 2010-02-17 |
| 1083848923 | Stoddard County Family Care LLC | Clinic/Center | 1300 N One Mile Rd, Dexter, MO 63841-1042 | 2009-05-06 |
| 1629111729 | Southeast Health Center of Stoddard County LLC | Clinic/Center | 1300 N One Mile Rd, Dexter, MO 63841-1042 | 2007-02-15 |
| 1790828812 | Southeast Health Center of Stoddard County, LLC | Clinic/Center | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2007-02-15 |
| 1710047618 | Southeast Health Center of Stoddard County, LLC | Clinic/Center | 1300 N One Mile Rd, Suite 2, Dexter, MO 63841-1042 | 2006-12-11 |
| 1083633374 | William Newton Memorial Hospital | Clinic/Center | 204 North Main, Dexter, KS 67038 | 2006-07-18 |
| Find all providers in DEXTER | ||||
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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.