SOUTHEAST MISSOURI HEALTH NETWORK (NPI# 1457570681) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457570681 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST MISSOURI HEALTH NETWORK |
| Other Organization Name | BOOTHEEL DENTAL CLINIC |
| Practice Address |
202b Main St New Madrid MO 63869-1911 |
| Mailing Address |
420 Semo Dr P.o. Box 400 New Madrid MO 63869-1734 |
| Practice Telephone | 5737485671 |
| Practice Fax Number | 5737485317 |
| Mailing Telephone | 5737482404 |
| Mailing Fax Number | 5737488929 |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2014-07-22 |
| Authorized Official Name | CHRISTOPHER JONES (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 5737482404 |
| Is Organization Subpart | Y |
| Parent Organization Name | SOUTHEAST MISSOURI HEALTH NETWORK |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 500704069 | 05 |
| Other Name | Type Code |
|---|---|
| BOOTHEEL DENTAL CLINIC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619513215 | Southeast Missouri Health Network | Clinic/Center | 835 W Murray Ln, Sikeston, MO 63801-4056 | 2019-11-19 |
| 1790257228 | Southeast Missouri Health Network | Physician Assistant | Kennett Middle School Clinic, 510 College Ave, Kennett, MO 63857-2062 | 2018-12-21 |
| 1679019491 | Southeast Missouri Health Network | Dentist | 111 Prairie Drive, East Prairie, MO 63845 | 2017-01-18 |
| 1649697566 | Southeast Missouri Health Network | Clinic/Center | Caruthersville Medical Center, 109 East 5th Street, Caruthersville, MO 63830-1417 | 2014-03-28 |
| 1528348778 | Southeast Missouri Health Network | Dentist | 6724 Highway 77 E, Benton, MO 63736 | 2011-08-19 |
| 1598069247 | Southeast Missouri Health Network | Dentist | 420 Semo Dr, New Madrid, MO 63869-1734 | 2011-01-10 |
| 1194945154 | Southeast Missouri Health Network | Clinic/Center | 741 S Walnut St, Bernie, MO 63822-8900 | 2007-05-01 |
| 1720209794 | Southeast Missouri Health Network | Clinic/Center | 700 N Douglass St, Malden, MO 63863-1510 | 2007-05-01 |
| 1609095975 | Southeast Missouri Health Network | Clinic/Center | 421 Semo Dr, New Madrid, MO 63869-1733 | 2007-04-25 |
| 1932108974 | Southeast Missouri Health Network | Clinic/Center | 6738 State Highway 77, Benton, MO 63736-8238 | 2005-07-20 |
| Street Address |
202B MAIN ST |
| City | NEW MADRID |
| State | MO |
| Zip Code | 63869-1911 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033237359 | Kristen Nelson | Dental Hygienist | 202b Main St, New Madrid, MO 63869-1911 | 2007-03-26 |
| 1659711596 | Blair Ray | Dental Hygienist | 202b Main St, New Madrid, MO 63869-1911 | 2013-06-25 |
| 1629196944 | Carrie L Gregory | Dental Hygienist | 202b Main St, New Madrid, MO 63869-1911 | 2007-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558924845 | Sierra Elaine Holiman | Nurse Practitioner | 800 Us Hwy 61, New Madrid, MO 63869 | 2019-04-22 |
| 1083143325 | Family Matters Home Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 985 Ramsey Lane, New Madrid, MO 63869 | 2017-06-09 |
| 1174849491 | Lorenzo Antonio Aquino Tolentino | Physical Therapist | 1050 Dawson Road, New Madrid, MO 63869 | 2010-04-12 |
| 1043467285 | Betty Ann Cagle | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 131 St. Thomas Lane, New Madrid, MO 63869 | 2008-08-19 |
| 1932372646 | Pemiscot County Memorial Hospital | Clinic/Center | 555 Virginia Ave, New Madrid, MO 63869 | 2008-04-03 |
| 1629138425 | Timothy P Rausch | Dentist | 645 Us Hwy 61, New Madrid, MO 63869 | 2006-12-11 |
| 1821628850 | Family Matters In Home LLC | In Home Supportive Care | 415 Main St, New Madrid, MO 63869 | 2020-01-17 |
| 1508314907 | Family Matters Cds LLC | Home Health | 413 Main Street, New Madrid, MO 63869 | 2016-09-14 |
| 1649657495 | Trusted Hands Direct LLC | In Home Supportive Care | 1 Courthouse Square, New Madrid, MO 63869 | 2015-04-30 |
| 1598161739 | Trusted Hands In Home Supportive Services | In Home Supportive Care | 1 Courthouse Square, New Madrid, MO 63869 | 2014-11-17 |
| Find all providers in zip 63869 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609095975 | Southeast Missouri Health Network | Clinic/Center | 421 Semo Dr, New Madrid, MO 63869-1733 | 2007-04-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952909079 | Northwest Health Services Inc | Clinic/Center | 202 S East St, Albany, MO 64402-1836 | 2020-10-12 |
| 1912505041 | Northwest Health Services Inc | Clinic/Center | 10500 State Route T, Savannah, MO 64485-2456 | 2020-10-12 |
| 1407469570 | Family Care Health Centers | Clinic/Center | 2717 Sidney Street, St. Louis, MO 63104 | 2020-08-28 |
| 1407478399 | Big Springs Medical Association | Clinic/Center | 2879 James Blvd, Poplar Bluff, MO 63901-3395 | 2020-05-13 |
| 1295356731 | Health Care Coalition of Lafayette County | Clinic/Center | 811 S Business Highway 13, Lexington, MO 64067-1515 | 2020-05-06 |
| 1376164699 | East Central Missouri Behavioral Health Services, Inc | Clinic/Center | 896 S Sturgeon St, Montgomery City, MO 63361-2716 | 2020-04-27 |
| 1750912044 | Northwest Health Services, Inc. | Clinic/Center | 418 E 2nd St, Maryville, MO 64468-1703 | 2020-01-27 |
| 1669003950 | Northwest Health Services, Inc. | Clinic/Center | 525 W South Hills Dr, Maryville, MO 64468-3653 | 2020-01-27 |
| 1063052553 | Compass Health, Inc. | Clinic/Center | 1319 E Highway 24 Ste B, Moberly, MO 65270-3682 | 2020-01-13 |
| 1407490741 | Advocates for A Healthy Community Inc | Clinic/Center | 2238 W Kingsley St, Springfield, MO 65807-5456 | 2019-10-30 |
| Find all providers with the same taxonomy | ||||
| City | NEW MADRID |
| Zip Code | 63869 |
Please comment or provide details below to improve the information on SOUTHEAST MISSOURI HEALTH NETWORK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.