# FAMILY MEDICINE OF SOUTHEAST MISSOURI, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619145612
- **Authorized official:** VICKI JANE ROBERTS M.D. (OWNER)
- **Authorized official phone:** (573) 620-6444

## Contact information

- **Practice address:** 808 E WAKEFIELD AVE, SIKESTON, MO 63801-5147
- **Practice address phone:** (573) 620-6444
- **Mailing address:** 808 E. WAKEFIELD AVENUE, FAMILY MEDCINE OF SOUTHEAST MISSOURI, SIKESTON, MO 63801-5100
- **Mailing address phone:** (573) 620-6444
- **Mailing address fax:** (888) 654-6599

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QR1300X | Rural Health Clinic/Center | 2005013758 | MO | — |

## Other

- **Enumeration date:** 02/13/2008
- **Last updated:** 09/08/2011