NPIMap

Organization Active NPI

Southeast Missouri Health Network

  • Dentist
  • East Prairie, MO
National Provider Identifier
1679019491
Registry record updated Nov 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SOUTHEAST MISSOURI HEALTH NETWORK
Practice address
111 Prairie Drive
East Prairie, MO 63845
Phone
(573) 649-9311
Fax
(573) 649-9331
NPI assigned
Jan 18, 2017
Last updated
Nov 9, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHEAST MISSOURI HEALTH NETWORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 9, 2017

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

Authorized official

Name
Sara Deane
Title
Cfo
Phone
(573) 313-2500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

111 Prairie Drive
East Prairie, MO 63845

Mailing address

111 Prairie Drive
East Prairie, MO 63845
Phone (573) 649-9311

Other practice location 1

111 Prairie Dr
Ste a & B
East Prairie, MO 63845-1114
Phone (573) 649-9311

National Provider Directory

National Provider Directory
Tax ID family
Southeast Missouri Network14 organizations share this tax ID, including this one
Part of
Southeast Missouri Network

Other organizations with this tax ID 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 2

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": "1484697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510185600000",
    "number": "1679019491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 PRAIRIE DRIVE",
            "city": "EAST PRAIRIE",
            "state": "MO",
            "postal_code": "63845",
            "telephone_number": "573-649-9311",
            "fax_number": "573-649-9331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 PRAIRIE DRIVE",
            "city": "EAST PRAIRIE",
            "state": "MO",
            "postal_code": "63845",
            "telephone_number": "573-649-9311",
            "fax_number": "573-649-9331"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Prairie Dr",
            "address_2": "STE A & B",
            "address_purpose": "LOCATION",
            "city": "East Prairie",
            "state": "MO",
            "postal_code": "638451114",
            "country_code": "US",
            "telephone_number": "573-649-9311",
            "fax_number": "573-649-9331",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHEAST MISSOURI HEALTH NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEAST MISSOURI HEALTH NETWORK",
        "enumeration_date": "2017-01-18",
        "last_updated": "2017-11-09",
        "status": "A",
        "authorized_official_last_name": "DEANE",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-313-2500"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Prairie, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2017; 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.