Provider Demographics
NPI:1679041040
Name:SOUTHEAST HEALTH CENTER OF STODDARD COUNTY LLC
Entity Type:Organization
Organization Name:SOUTHEAST HEALTH CENTER OF STODDARD COUNTY LLC
Other - Org Name:MERCY HOSPITAL STODDARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-331-6028
Mailing Address - Street 1:1200 N ONE MILE RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-1000
Mailing Address - Country:US
Mailing Address - Phone:573-614-1900
Mailing Address - Fax:573-624-8895
Practice Address - Street 1:522 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5812
Practice Address - Country:US
Practice Address - Phone:573-624-1901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health