NPIMap

Organization Active NPI

Southeast Missouri Health Network

  • Federally Qualified Health Center (FQHC)
  • Sikeston, MO
National Provider Identifier
1104045475
Registry record updated Apr 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Apr 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sara Deane
Title
Chief Financial Officer
Phone
(573) 313-2500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

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 names 1

  • Sikeston Medical Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104045475. Details of each certification follow.

  • CCN 261826 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 261826

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SOUTHEAST MISSOURI HEALTH NETWORK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1992
Last certification
Oct 1, 1992
Ownership / control type
For profit – partnership
Facility address
200 Southland Drive
Sikeston, MO 63801

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0687481Southeast Missouri Health Network200 Southland Drive, Sikeston, MO 63801Certificate of waiverMar 30, 2027

National Provider Directory

National Provider Directory

Locations

1400 W Washington St
Kennett, MO 63857
Phone (573) 313-2500

835 W Murray Ln
Sikeston, MO 63801
Phone (573) 472-8808

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586822400000",
    "number": "1104045475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6738 STATE HIGHWAY 77",
            "city": "BENTON",
            "state": "MO",
            "postal_code": "637368238",
            "telephone_number": "573-313-2500",
            "fax_number": "573-313-2505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SOUTHLAND DR",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638014403",
            "telephone_number": "573-472-1770",
            "fax_number": "573-472-4050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MISSOURI HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A",
        "authorized_official_last_name": "DEANE",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "573-313-2500"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sikeston Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sikeston, MO

Sources for this page

Verify at the official NPI Registry.