Provider Demographics
NPI:1679019491
Name:SOUTHEAST MISSOURI HEALTH NETWORK
Entity Type:Organization
Organization Name:SOUTHEAST MISSOURI HEALTH NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-313-2500
Mailing Address - Street 1:111 PRAIRIE DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAST PRAIRIE
Mailing Address - State:MO
Mailing Address - Zip Code:63845
Mailing Address - Country:US
Mailing Address - Phone:573-649-9311
Mailing Address - Fax:573-649-9331
Practice Address - Street 1:111 PRAIRIE DRIVE
Practice Address - Street 2:
Practice Address - City:EAST PRAIRIE
Practice Address - State:MO
Practice Address - Zip Code:63845
Practice Address - Country:US
Practice Address - Phone:573-649-9311
Practice Address - Fax:573-649-9331
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST MISSOURI HEALTH NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-18
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty