SOUTHEAST MISSOURI STATE UNIVERSITY (NPI# 1871003301) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871003301 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST MISSOURI STATE UNIVERSITY |
| Other Organization Name | SEMO STATE SPORTS MEDICINE |
| Practice Address |
1 University Plz # Ms 0200 Cape Girardeau MO 63701-4710 |
| Mailing Address |
5050 Spring Valley Rd Dallas TX 75244-3995 |
| Practice Telephone | 9723674845 |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2017-10-11 |
| Authorized Official Name | MOUZON BASS III (AGENT) |
| Authorized Official Telephone | 9723674845 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2081S0010X |
Physical Medicine & Rehabilitation Specialization: Sports Medicine |
2007008844 | MO | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| SEMO State Sports Medicine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780753640 | Southeast Missouri State University | Day Training, Developmentally Disabled Services | 2100 Themis St Ste 103c, Cape Girardeau, MO 63701-5124 | 2006-11-07 |
| 1295014470 | Southeast Missouri State University | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2100 Themis St Ste 103c, Cape Girardeau, MO 63701-5124 | 2011-08-05 |
| Street Address |
1 UNIVERSITY PLZ # MS 0200 |
| City | CAPE GIRARDEAU |
| State | MO |
| Zip Code | 63701-4710 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336748110 | Westbrook Dialysis, LLC | Clinic/Center | 140 West Drive, Cape Girardeau, MO 63701 | 2020-10-22 |
| 1972079580 | Savannah Laine Menard | Behavior Technician | 20 S. Sprigg St, Cape Girardeau, MO 63701 | 2018-10-22 |
| 1932690377 | Broadway Specialty, LLC | Pharmacy | 706 Broadway St, Cape Girardeau, MO 63701 | 2018-05-22 |
| 1356864649 | Terri L. Mccord | Pharmacist | 4170 Connor Dr, Cape Girardeau, MO 63701 | 2017-07-19 |
| 1013459312 | Christina Cossou | Nurse Practitioner | 2116 Megan Dr Ste 102, Cape Girardeau, MO 63701 | 2016-11-17 |
| 1124573365 | Ashley Sullivan | Massage Therapist | 3041 Melrose Ave, Cape Girardeau, MO 63701 | 2016-08-17 |
| 1225432172 | Axpm - Merkley, LLC | Dentist | 2116 Megan Dr., Suite 101, Cape Girardeau, MO 63701 | 2014-10-21 |
| 1639573397 | Marian Perez Hurt | Physical Therapist | 2001 N. Kingshighway, Fountainbleau Lodge, Cape Girardeau, MO 63701 | 2014-10-09 |
| 1891194213 | Deanna Abner | Case Manager/Care Coordinator | 20 South Sprigg, Cape Girardeau, MO 63701 | 2014-08-21 |
| 1831506880 | Kwadwo O Britwum | Behavioral Analyst | Morningstar Behavioral Associates, 338 W. Broadway Suite 301, Cape Girardeau, MO 63701 | 2014-07-22 |
| Find all providers in zip 63701 | ||||
| Taxonomy Code | 2081S0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Sports Medicine |
| A physician who specializes in Sports Medicine is responsible for continuous care related to the enhancement of health and fitness as well as the prevention of injury and illness. The specialist possesses knowledge and experience in the promotion of wellness and the prevention of injury from many areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation and injuries. It is the goal of a Sports Medicine specialist to improve the healthcare of the individual engaged in physical exercise. |
| Notes: Source: American Board of Medical Specialties, 2009. www.abms.org [7/1/2009: definition added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073541827 | Jimmy Dayland Bowen | Physical Medicine & Rehabilitation | 48 Doctors Park, Cape Girardeau, MO 63703-4928 | 2006-06-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073166864 | Bryan Bengston | Physical Medicine & Rehabilitation | 624 Sessions Ave, Saint Louis, MO 63126-1030 | 2019-07-20 |
| 1760627327 | Zachary C Roberts | Physical Medicine & Rehabilitation | Msu Athletic Training Services, 901 S. National Ave., Springfield, MO 65897-0001 | 2008-12-11 |
| 1144214065 | Ravi Yadava | Physical Medicine & Rehabilitation | 675 Old Ballas Rd, Suite 210, Saint Louis, MO 63141-7083 | 2005-09-07 |
| 1154939346 | Tara Grace Porter | Physical Medicine & Rehabilitation | 1480 8th St, West Plains, MO 65775-2010 | 2020-07-14 |
| 1184258188 | Jessica Nicole Bledsoe | Physical Medicine & Rehabilitation | 3302 N Woodbine Rd, Saint Joseph, MO 64505-9323 | 2020-02-27 |
| 1073168399 | Logan Prescott | Physical Medicine & Rehabilitation | 3545 S National Ave, Springfield, MO 65807-7310 | 2019-08-04 |
| 1487134722 | Connor Parrish | Physical Medicine & Rehabilitation | 4331 S Fremont Ave, Springfield, MO 65804-7328 | 2018-08-16 |
| 1235649211 | Sydni Marie Kaden | Physical Medicine & Rehabilitation | 802 N Riverside Rd Ste 130, Saint Joseph, MO 64507-2508 | 2017-10-04 |
| 1184162414 | Kirstin Arnold | Physical Medicine & Rehabilitation | 3222 W 16th St, Sedalia, MO 65301-2105 | 2017-02-07 |
| 1326466590 | Chelsea Hoggard | Physical Medicine & Rehabilitation | 2725 N Westwood Blvd, Poplar Bluff, MO 63901-2346 | 2014-04-03 |
| Find all providers with the same taxonomy | ||||
| City | CAPE GIRARDEAU |
| Zip Code | 63701 |
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| 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.