SOUTHEAST HEALTH CENTER OF STODDARD COUNTY LLC (NPI# 1629111729) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629111729 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST HEALTH CENTER OF STODDARD COUNTY LLC |
| Other Organization Name | SOUTHEASTHEALTH INTERNAL MEDICINE OF DEXTER |
| Practice Address |
1300 N One Mile Rd Dexter MO 63841-1042 |
| Mailing Address |
Po Box 368 Dexter MO 63841-0368 |
| Practice Telephone | 5736141951 |
| Mailing Telephone | 5736141951 |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2015-12-01 |
| Authorized Official Name | KATHY VICKERY (VICE PRESIDENT REGIONAL OPERATIONS) |
| Authorized Official Telephone | 5736141901 |
| 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 | 595968900 | 05 | |
| RAILROAD MEDICARE | DC5219 | 01 |
| Other Name | Type Code |
|---|---|
| SoutheastHEALTH Internal Medicine of Dexter | 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 |
| 1265575385 | Southeast Health Center of Stoddard County LLC | Clinic/Center | 1003 State Hwy 25 North, Bloomfield, MO 63825 | 2007-02-15 |
| 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 |
| Street Address |
1300 N ONE MILE RD |
| City | DEXTER |
| State | MO |
| Zip Code | 63841-1042 |
| 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 |
| 1083848923 | Stoddard County Family Care LLC | Clinic/Center | 1300 N One Mile Rd, Dexter, MO 63841-1042 | 2009-05-06 |
| 1528273117 | Stacey Grays | Nurse Practitioner | 1300 N One Mile Rd, Dexter, MO 63841-1042 | 2007-05-14 |
| 1649399031 | Jean Brown | Nurse Practitioner | 1300 N One Mile Rd, Suite 1, Dexter, MO 63841-1042 | 2007-03-28 |
| 1073656153 | Dexter Hospital LLC | Pediatrics | 1300 N One Mile Rd, Suite 2, Dexter, MO 63841-1042 | 2007-02-15 |
| 1629132790 | Dexter Hospital LLC | Surgery | 1300 N One Mile Rd, Suite 7, Dexter, MO 63841 | 2006-12-21 |
| 1780745414 | Dexter Hospital LLC | Surgery | 1300 N One Mile Rd, Suite 5, Dexter, MO 63841 | 2006-12-13 |
| 1477613370 | Dexter Hosptial LLC | Internal Medicine | 1300 N One Mile Rd, Suite 1, Dexter, MO 63841 | 2006-12-11 |
| 1710047618 | Southeast Health Center of Stoddard County, LLC | Clinic/Center | 1300 N One Mile Rd, Suite 2, Dexter, MO 63841-1042 | 2006-12-11 |
| 1578528618 | Reza Jalal | Internal Medicine | 1300 N One Mile Rd, Suite 1, Dexter, MO 63841-1042 | 2006-04-20 |
| 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 | 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 |
| 1457660045 | Southeast Health Center of Stoddard County, LLC | Clinic/Center | 2025 W Business Us Highway 60, Dexter, MO 63841-2879 | 2010-09-29 |
| 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 |
| 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.