NPIMap

Organization Active NPI

Southeast Missouri Health Network

Doing business as Bootheel Dental Clinic

  • Federally Qualified Health Center (FQHC)
  • New Madrid, MO
National Provider Identifier
1457570681
Registry record updated Jul 22, 2014
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
Doing business as
Bootheel Dental Clinic
Practice address
202B Main St
New Madrid, MO 63869-1911
Phone
(573) 748-5671
Fax
(573) 748-5317
NPI assigned
Apr 25, 2007
Last updated
Jul 22, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHEAST MISSOURI HEALTH NETWORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 22, 2014

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

Authorized official

Name
Christopher Jones
Title
Chief Executive Officer
Phone
(573) 748-2404

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

202B Main St
New Madrid, MO 63869-1911

Mailing address

420 Semo Dr
P.O. Box 400
New Madrid, MO 63869-1734
Phone (573) 748-2404

Other identifiers 1

IdentifierTypeStateIssuer
500704069MedicaidMO

Other names 1

  • BOOTHEEL DENTAL CLINIC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lilbourn Community HLTH14 organizations share this tax ID, including this one
Part of
Lilbourn Community HLTH

Other organizations with this tax ID 13

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

View all 13

Locations

202B Main St
New Madrid, MO 63869
Phone (573) 748-5671

Practitioners & affiliated clinicians

Practitioners 3

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.

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": "1405987200000",
    "number": "1457570681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 SEMO DR",
            "address_2": "P.O. BOX 400",
            "city": "NEW MADRID",
            "state": "MO",
            "postal_code": "638691734",
            "telephone_number": "573-748-2404",
            "fax_number": "573-748-8929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202B MAIN ST",
            "city": "NEW MADRID",
            "state": "MO",
            "postal_code": "638691911",
            "telephone_number": "573-748-5671",
            "fax_number": "573-748-5317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MISSOURI HEALTH NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEAST MISSOURI HEALTH NETWORK",
        "enumeration_date": "2007-04-25",
        "last_updated": "2014-07-22",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "573-748-2404"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500704069",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BOOTHEEL DENTAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Madrid, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.