NPIMap

Organization Active NPI

Southeast Missouri Behavioral Health

  • Substance Abuse Rehabilitation Facility
  • Poplar Bluff, MO
National Provider Identifier
1134492390
Registry record updated Feb 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
SOUTHEAST MISSOURI BEHAVIORAL HEALTH
Practice address
101 S Main St
Poplar Bluff, MO 63901-5843
Phone
(573) 686-5090
NPI assigned
Feb 20, 2012
Last updated
Feb 20, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2012

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

Authorized official

Name
Dr. Barron E Pratte, PH.D.
Title
President/Ceo
Phone
(573) 431-0554

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

101 S Main St
Poplar Bluff, MO 63901-5843

Mailing address

101 S Main St
Poplar Bluff, MO 63901-5843
Phone (573) 686-5090

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
26D2337477Southeast Missouri Behavioral Health -101 South Main Street, Poplar Bluff, MO 63901Certificate of waiverJan 22, 2028

National Provider Directory

National Provider Directory
Tax ID family
Southeast Missouri Behavioral Health15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

101 S Main St
Poplar Bluff, MO 63901
Phone (573) 624-6937

NPI Registry JSON

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

{
    "created_epoch": "1329696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329696000000",
    "number": "1134492390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 S MAIN ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639015843",
            "telephone_number": "573-686-5090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S MAIN ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639015843",
            "telephone_number": "573-686-5090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MISSOURI BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-20",
        "last_updated": "2012-02-20",
        "status": "A",
        "authorized_official_last_name": "PRATTE",
        "authorized_official_first_name": "BARRON",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "573-431-0554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poplar Bluff, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.