NPIMap

Organization Active NPI

Southeast Health Center of Stoddard County, LLC

  • Rural Health Clinic/Center
  • Dexter, MO
National Provider Identifier
1710047618
Registry record updated Oct 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC
Doing business as
SoutheastHEALTH Children's Clinic of Dexter
Practice address
1300 N One Mile Rd
Suite 2
Dexter, MO 63841-1042
Phone
(573) 624-7662
NPI assigned
Dec 11, 2006
Organization subpart
Yes
Parent organization
SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 18, 2013

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

Authorized official

Name
Paula E Harris
Title
Vice President Regional Operations
Phone
(573) 778-0020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X MO Primary

Addresses

Primary practice location

1300 N One Mile Rd
Suite 2
Dexter, MO 63841-1042

Mailing address

PO Box 368
Dexter, MO 63841-0368
Phone (573) 624-3165

Other identifiers 1

IdentifierTypeStateIssuer
595969007MedicaidMO

Other names 1

  • SoutheastHEALTH Children's Clinic of Dexter Doing business as

National Provider Directory

National Provider Directory
Part of
Southeast Health Center of Stoddard County LLC

Member of 2

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

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382054400000",
    "number": "1710047618",
    "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": "573-624-3165",
            "fax_number": "573-624-3157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N ONE MILE RD",
            "address_2": "SUITE 2",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "638411042",
            "telephone_number": "573-624-7662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC",
        "enumeration_date": "2006-12-11",
        "last_updated": "2013-10-18",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "VICE PRESIDENT  REGIONAL OPERATIONS",
        "authorized_official_telephone_number": "573-778-0020"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "595969007",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SoutheastHEALTH Children's Clinic of Dexter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dexter, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2013; 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.