Southeast Missouri Health Network
Organization Active NPI Federally Qualified Health Center (FQHC) · Sikeston, MO
NPI 1104045475 · NPPES record last updated Apr 14, 2020
Key facts
- NPI
- 1104045475
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SOUTHEAST MISSOURI HEALTH NETWORK
- Practice address
- 200 Southland Dr
Sikeston, MO 63801-4403 - Phone
- (573) 472-1770
- Fax
- (573) 472-4050
- NPI assigned
- Apr 25, 2007
- Organization subpart
- No
Authorized official
- Name
- Sara Deane
- Title
- Chief Financial Officer
- Phone
- (573) 313-2500
Other NPIs on the same Medicare enrollment 9
Practitioners 27
-
Taylor Rae Altenthal, APRN
-
Samantha Anne Duffel, LCSW
-
Tia Heskett, APRN
-
Nelson R Perez, MD
-
Amberly D Pritchard, LPC, NCC
-
Sydney Justine Vangennip, MSN, APRN, FNP-C
-
Lori Adell, DDS
-
Summer Alexander, NP
-
Autumn Lynnette Allgood, FNP-C
-
Amanda Elaine Bader, FNP-BC
-
William Bradley, FNP
-
Marilyn Y Chapman, FNP
-
Blake Essner, DDS
-
Judith Haggard, FNP
-
Delayna Michele Hunter, FNP-C
-
Seth Tyler Koehler, D.O.
-
Jessica Pickel, DENTAL HYGENTIST
-
Gail Redman, DDS
-
Nathan Sprengel, DO
-
Kristina Lynn Wadley, FNP-C
-
Ashley Zeigler, DENTAL HYGENTIST
-
Barbara K Collier, FNP
-
Gustavo Granada, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0687481 | Southeast Missouri Health Network | Certificate of waiver | Mar 30, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050412000011 | MO | Part B Supplier - Clinic/Group Practice | 6507818044 |
Receives reassigned benefits from 20 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Caruthersville, MO; Sikeston, MO; New Madrid, MO; Kennett, MO; Bernie, MO; Benton, MO |
National Provider Directory
Locations
6724 State Highway 77
Benton, MO 63736
Phone (573) 545-4191
500 Russell St
Kennett, MO 63857
Phone (573) 717-1332
835 W Murray Ln
Sikeston, MO 63801
Phone (573) 472-8808
200 Southland Dr
Sikeston, MO 63801
Phone (573) 472-1770
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
200 Southland Dr
Sikeston, MO 63801-4403
Mailing address
6738 State Highway 77
Benton, MO 63736-8238
Phone (573) 313-2500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500704028 | Medicaid | MO |
Other names
- Sikeston Medical Center
Other providers in Sikeston, MO
- Zachary Gerard Smith
- Rebecca Ann Snyder
- Kendra Sokolowski
- South Scott County Ambulance
- Southeast Health Center of Stoddard County LLC
- Southeast Missouri Health Network
- Southeast Missouri Health Network
- Southeast Missouri Health Network
- Southeast Missouri Urology Consultants PC
- Sovereign Healthcare Group, LLC
All providers in Sikeston, MO · Federally Qualified Health Center (FQHC) in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.