Southeast Health Center of Stoddard County LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

SOUTHEAST HEALTH CENTER OF STODDARD COUNTY LLC

Doing business as

SoutheastHEALTH Internal Medicine of Dexter

Practice address

1300 N One Mile Rd
Dexter, MO 63841-1042

Phone

(573) 614-1951

NPI assigned

Feb 15, 2007

Organization subpart

No

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

Authorized official

Name

Kathy Vickery

Title

Vice President Regional Operations

Phone

(573) 614-1901

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• SoutheastHEALTH Internal Medicine of Dexter Doing business as

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Southeast Health Center of Stoddard County LLC

  • Family Medicine Physician
  • Dexter, MO
  • NPI 1477997567

  Member Of

  NPD member
• Southeast Hospital

  • General Acute Care Hospital
  • Cape Girardeau, MO
  • NPI 1811006661

  Member Of

  NPD member

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448928000000",
    "number": "1629111729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 368",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "638410368",
            "telephone_number": "573-614-1951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N ONE MILE RD",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "638411042",
            "telephone_number": "573-614-1951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST HEALTH CENTER OF STODDARD COUNTY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2015-12-01",
        "status": "A",
        "authorized_official_last_name": "VICKERY",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "VICE PRESIDENT REGIONAL OPERATIONS",
        "authorized_official_telephone_number": "573-614-1901"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "595968900",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC5219",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SoutheastHEALTH Internal Medicine of Dexter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sikeston Hearing Aid Center
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• William Simmons
• Smiles of Hope, Inc
• Southeast Health Center of Stoddard County LLC
• Southeast Health Center of Stoddard County, LLC
• Southeast Health Center of Stoddard County, LLC
• Southeast Health Center of Stoddard County, LLC
• Southeast Health Center of Stoddard County, LLC
• Southeast Health Center of Stoddard County, LLC

• Rural Health Clinic/Center in Dexter, MO
• Providers in Dexter, MO by specialty
• Rural Health Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2015; 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.