Organization
SOUTHEAST MISSOURI HEALTH NETWORK
Active
Other names
benton medical center
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS JONES (CHIEF EXECUTIVE OFFICER)
(573) 748-2404
Entity
Organization
Contact information
Practice address
6724 HIGHWAY 77 E, BENTON, MO 63736
(573) 545-4191
(573) 545-4425
Mailing address
420 SEMO DR, 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
—
1497035661
—
MO
Enumeration date
08/19/2011
Last updated
08/06/2014
Update your record
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