Southeast Missouri Health Network

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

SOUTHEAST MISSOURI HEALTH NETWORK

Practice address

200 Pine St
Sikeston, MO 63801-3258

Phone

(573) 472-8850

NPI assigned

Nov 20, 2019

Last updated

Apr 14, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sara Deane, CFO

Title

Chief Financial Officer

Phone

(573) 313-2500

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Sikeston High School Clinic Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770129199. Details of each certification follow.

• CCN 261183 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 261183

Legal name

SIKESTON HIGH SCHOOL CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Dec 4, 2019

Last certification

Dec 4, 2019

Ownership / control type

For profit – corporation

Facility address

200 Pine St
Sikeston, MO 63801

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1574208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586822400000",
    "number": "1770129199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6738 STATE HIGHWAY 77",
            "city": "BENTON",
            "state": "MO",
            "postal_code": "637368238",
            "telephone_number": "573-313-2500",
            "fax_number": "573-313-2505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PINE ST",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638013258",
            "telephone_number": "573-472-8850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MISSOURI HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-20",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A",
        "authorized_official_last_name": "DEANE",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "573-313-2500",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500077980",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sikeston High School Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• South Scott County Ambulance
• Southeast Health Center of Stoddard County LLC (Mercy Hospital Stoddard)
• Southeast Missouri Health Network
• Southeast Missouri Health Network (SIKESTON DENTAL Center)
• Southeast Missouri Health Network
• Southeast Missouri Urology Consultants PC
• Sovereign Healthcare Group, LLC
• Chester Arthur Spears, M.D.
• St. Louis JC Vamc
• Donna Lee Stallings, MAED, CCC-SLP

• Federally Qualified Health Center (FQHC) in Sikeston, MO
• Providers in Sikeston, MO by specialty
• Federally Qualified Health Center (FQHC) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.