Provider Demographics
NPI:1255486767
Name:SOUTHEAST MISSOURI UNIVERSITY
Entity type:Organization
Organization Name:SOUTHEAST MISSOURI UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPOE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLTZ-SCHLEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-290-5595
Mailing Address - Street 1:1 UNIVERSITY PLZ MSC 9425
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4710
Mailing Address - Country:US
Mailing Address - Phone:573-290-5595
Mailing Address - Fax:573-290-5128
Practice Address - Street 1:621 N FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-7244
Practice Address - Country:US
Practice Address - Phone:573-290-5595
Practice Address - Fax:573-290-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable