# SOUTHEAST MISSOURI HOSPITAL PHYSICIANS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southeast Primary Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700350543
- **Authorized official:** KRISTA BERRY (CFO)
- **Authorized official phone:** (573) 331-6028

## Contact information

- **Practice address:** 624 OLD SAINT MARYS RD, PERRYVILLE, MO 63775-1837
- **Practice address phone:** (573) 547-3232
- **Practice address fax:** (573) 547-3231
- **Mailing address:** 1701 LACEY ST, CAPE GIRARDEAU, MO 63701-5230

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/15/2019
- **Last updated:** 01/15/2019