Provider Demographics
NPI:1356689905
Name:SOUTHEAST HEALTH CENTER OF REYNOLDS COUNTY LLC
Entity type:Organization
Organization Name:SOUTHEAST HEALTH CENTER OF REYNOLDS COUNTY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-996-2141
Mailing Address - Street 1:109 PLUM ST
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:MO
Mailing Address - Zip Code:63935-1277
Mailing Address - Country:US
Mailing Address - Phone:573-996-2141
Mailing Address - Fax:573-996-3949
Practice Address - Street 1:100 HWY 21
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:MO
Practice Address - Zip Code:63638-7943
Practice Address - Country:US
Practice Address - Phone:573-996-2141
Practice Address - Fax:573-996-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO261339Medicare Oscar/Certification