SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC (NPI# 1568524437) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568524437 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC |
| Other Organization Name | SOUTHEASTHEALTH FAMILY MEDICINE OF DEXER |
| Practice Address |
1200 N One Mile Rd Dexter MO 63841-1000 |
| Mailing Address |
Po Box 368 Dexter MO 63841 |
| Practice Telephone | 5736247575 |
| Mailing Telephone | 5736243165 |
| Mailing Fax Number | 5736243157 |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2014-09-22 |
| Authorized Official Name | PAULA E HARRIS (VICE PRESIDENT REGIONAL OPERATIONS) |
| Authorized Official Telephone | 5737780020 |
| 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 | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | RAILROAD MEDICARE | DC5315 | 01 |
| MO | 509684809 | 05 |
| Other Name | Type Code |
|---|---|
| SoutheastHEALTH Family Medicine of Dexer | 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 |
| 1457660045 | Southeast Health Center of Stoddard County, LLC | Clinic/Center | 2025 W Business Us Highway 60, Dexter, MO 63841-2879 | 2010-09-29 |
| 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 |
| 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 |
1200 N ONE MILE RD |
| City | DEXTER |
| State | MO |
| Zip Code | 63841-1000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578557872 | Mina K Massey | Family Medicine | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2005-09-01 |
| 1255801247 | Kristin Suzanne Wheeler Guethle | Nurse Practitioner | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2018-12-03 |
| 1013493865 | Kerri Crawley | Nurse Practitioner | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2018-07-16 |
| 1578080214 | Stoddard Emergency Group, LLC | Physician Assistant | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2017-08-24 |
| 1851765614 | Leah Legrand | Nurse Practitioner | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2015-11-17 |
| 1841685989 | Angela Weiss | Nurse Practitioner | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2015-04-06 |
| 1356762132 | Meramec Emergency Physicians, LLP | Hospitalist | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2013-12-23 |
| 1407100944 | Tory L Sherman | Physician Assistant | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2012-11-06 |
| 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 |
| 1396945663 | Cory W Blocker | Nurse Practitioner | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2007-07-24 |
| Find all providers in the same location | ||||
| 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 | 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 |
|---|---|---|---|---|
| 1023541265 | Saint Francis Medical Center | Family Medicine | 1212 Saint Francis Dr, Dexter, MO 63841-2769 | 2017-04-05 |
| 1366831943 | Saint Francis Medical Center | Family Medicine | 1212 Saint Francis Drive, Dexter, MO 63841-1212 | 2015-01-20 |
| 1427350594 | Dexter Hospital LLC | Family Medicine | 2025 W Bus Hwy 60, Dexter, MO 63841 | 2010-11-23 |
| 1225268618 | Practice Tee, LLC | Family Medicine | 1523 W Business Hwy 60, Dexter, MO 63841 | 2009-07-20 |
| 1891964185 | Patrick Munson Mdpc | Family Medicine | 3141 Baker Rd, Dexter, MI 48130-1103 | 2008-02-21 |
| 1710056213 | Dexter Hospital LLC | Family Medicine | 1525 W Business Hwy 60, Dexter, MO 63841 | 2006-11-07 |
| 1619066560 | Theresa R Peters | Family Medicine | 7300 Dexiter-ann Arbor Rd, Dexter, MI 48130-8598 | 2006-10-11 |
| 1578521894 | Michael M Mckee | Family Medicine | 7300 Dexter Ann Arbor Rd, Dexter, MI 48130-8598 | 2006-05-03 |
| 1346205325 | John T Blair | Family Medicine | 115 East Business Highway 60, Dexter, MO 63841 | 2006-04-20 |
| 1043209836 | Robert J Jibben | Family Medicine | 1523 Business Hwy 60 W, Ste A1, Dexter, MO 63841 | 2005-10-14 |
| 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.