SOUTHEAST MISSOURI HEALTH NETWORK (NPI# 1710108766) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710108766 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST MISSOURI HEALTH NETWORK |
| Other Organization Name | OTTO BEAN MEDICAL CENTER |
| Practice Address |
500 Russell St Kennett MO 63857-2102 |
| Mailing Address |
6738 State Highway 77 Benton MO 63736-8238 |
| Practice Telephone | 5737171332 |
| Practice Fax Number | 5737171335 |
| Mailing Telephone | 5733132500 |
| Mailing Fax Number | 5733132505 |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2020-04-14 |
| Authorized Official Name | SARA DEANE (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 5733132500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 500704036 | 05 |
| Other Name | Type Code |
|---|---|
| otto bean medical center | Doing Business As Name - Organization |
| Otto Bean Medical Clinic | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619513215 | Southeast Missouri Health Network | Clinic/Center | 835 W Murray Ln, Sikeston, MO 63801-4056 | 2019-11-19 |
| 1790257228 | Southeast Missouri Health Network | Physician Assistant | Kennett Middle School Clinic, 510 College Ave, Kennett, MO 63857-2062 | 2018-12-21 |
| 1679019491 | Southeast Missouri Health Network | Dentist | 111 Prairie Drive, East Prairie, MO 63845 | 2017-01-18 |
| 1649697566 | Southeast Missouri Health Network | Clinic/Center | Caruthersville Medical Center, 109 East 5th Street, Caruthersville, MO 63830-1417 | 2014-03-28 |
| 1528348778 | Southeast Missouri Health Network | Dentist | 6724 Highway 77 E, Benton, MO 63736 | 2011-08-19 |
| 1598069247 | Southeast Missouri Health Network | Dentist | 420 Semo Dr, New Madrid, MO 63869-1734 | 2011-01-10 |
| 1194945154 | Southeast Missouri Health Network | Clinic/Center | 741 S Walnut St, Bernie, MO 63822-8900 | 2007-05-01 |
| 1720209794 | Southeast Missouri Health Network | Clinic/Center | 700 N Douglass St, Malden, MO 63863-1510 | 2007-05-01 |
| 1609095975 | Southeast Missouri Health Network | Clinic/Center | 421 Semo Dr, New Madrid, MO 63869-1733 | 2007-04-25 |
| 1932108974 | Southeast Missouri Health Network | Clinic/Center | 6738 State Highway 77, Benton, MO 63736-8238 | 2005-07-20 |
| Street Address |
500 RUSSELL ST |
| City | KENNETT |
| State | MO |
| Zip Code | 63857-2102 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467946434 | Panagiota Sandoval | Dentist | 500 Russell St, Kennett, MO 63857-2102 | 2018-06-21 |
| 1588158554 | Andrew Audel Sandoval | Dentist | 500 Russell St, Kennett, MO 63857-2102 | 2018-06-21 |
| 1639591506 | Delayna Michele Hunter | Registered Nurse | 500 Russell St, Kennett, MO 63857-2102 | 2014-01-13 |
| 1285996470 | Tina L Carter | Social Worker | 500 Russell St, Kennett, MO 63857-2102 | 2012-06-13 |
| 1013229749 | Southeast Missouri Health Network | Clinic/Center | 500 Russell St, Kennett, MO 63857-2102 | 2010-07-10 |
| 1619088390 | Judith Haggard | Nurse Practitioner | 500 Russell St, Kennett, MO 63857-2102 | 2006-08-31 |
| 1821013400 | Valerie A Smith | Family Medicine | 500 Russell St, Kennett, MO 63857-2102 | 2006-07-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992278139 | Fancilla Adams | Counselor | 925 State Highway V V, Kennett, MO 63857 | 2019-01-10 |
| 1962994418 | Kiana Alexis Brown | Behavior Technician | 925 Highway W, Kennett, MO 63857 | 2018-05-31 |
| 1568953636 | Doctors Health Group, Inc | Family Medicine | 1312 First Street, Kennett, MO 63857 | 2018-05-24 |
| 1003328873 | Ann Graf | Counselor | 925 Vv, Kennett, MO 63857 | 2017-11-01 |
| 1457872160 | Jessica Luster | Technician, Other | 1109 Jones St., Kennett, MO 63857 | 2017-07-03 |
| 1235669128 | Chandra Celeste Perkins-shannon | Case Manager/Care Coordinator | 925 Hwy V, Kennett, MO 63857 | 2017-06-14 |
| 1467991612 | Sarah Lobdell | Case Manager/Care Coordinator | 925 State Highway Vv, Kennett, MO 63857 | 2017-02-21 |
| 1881132900 | Brandy Rios | Community Health Worker | 935 State Hwy Vv, Kennett, MO 63857 | 2017-02-09 |
| 1295272060 | Johnny Marie Johnson | Case Manager/Care Coordinator | 925 Hwy Vv Family Counseling Center, Kennett, MO 63857 | 2017-01-31 |
| 1043756364 | Heather Bowman | Case Manager/Care Coordinator | 875 Hwy Vv, Kennett, MO 63857 | 2017-01-10 |
| Find all providers in zip 63857 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013229749 | Southeast Missouri Health Network | Clinic/Center | 500 Russell St, Kennett, MO 63857-2102 | 2010-07-10 |
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|---|---|---|---|---|
| 1952909079 | Northwest Health Services Inc | Clinic/Center | 202 S East St, Albany, MO 64402-1836 | 2020-10-12 |
| 1912505041 | Northwest Health Services Inc | Clinic/Center | 10500 State Route T, Savannah, MO 64485-2456 | 2020-10-12 |
| 1407469570 | Family Care Health Centers | Clinic/Center | 2717 Sidney Street, St. Louis, MO 63104 | 2020-08-28 |
| 1407478399 | Big Springs Medical Association | Clinic/Center | 2879 James Blvd, Poplar Bluff, MO 63901-3395 | 2020-05-13 |
| 1295356731 | Health Care Coalition of Lafayette County | Clinic/Center | 811 S Business Highway 13, Lexington, MO 64067-1515 | 2020-05-06 |
| 1376164699 | East Central Missouri Behavioral Health Services, Inc | Clinic/Center | 896 S Sturgeon St, Montgomery City, MO 63361-2716 | 2020-04-27 |
| 1750912044 | Northwest Health Services, Inc. | Clinic/Center | 418 E 2nd St, Maryville, MO 64468-1703 | 2020-01-27 |
| 1669003950 | Northwest Health Services, Inc. | Clinic/Center | 525 W South Hills Dr, Maryville, MO 64468-3653 | 2020-01-27 |
| 1063052553 | Compass Health, Inc. | Clinic/Center | 1319 E Highway 24 Ste B, Moberly, MO 65270-3682 | 2020-01-13 |
| 1407490741 | Advocates for A Healthy Community Inc | Clinic/Center | 2238 W Kingsley St, Springfield, MO 65807-5456 | 2019-10-30 |
| Find all providers with the same taxonomy | ||||
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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.