Organization
SOUTHEAST MISSOURI HEALTH NETWORK
Active
Parent organization
SOUTHEAST MISSOURI HEALTH NETWORK
Other names
BOOTHEEL DENTAL CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEAST MISSOURI HEALTH NETWORK
Authorized official
CHRISTOPHER JONES (CHIEF EXECUTIVE OFFICER)
(573) 748-2404
Entity
Organization
Contact information
Practice address
202B MAIN ST, NEW MADRID, MO 63869-1911
(573) 748-5671
(573) 748-5317
Mailing address
420 SEMO DR, P.O. BOX 400, NEW MADRID, MO 63869-1734
(573) 748-2404
(573) 748-8929
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500704069
—
MO
Enumeration date
04/25/2007
Last updated
07/22/2014
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