Organization
SOUTHEAST HEALTH CENTER OF STODDARD COUNTY LLC
Active
Other names
SoutheastHEALTH Internal Medicine of Dexter
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY VICKERY (VICE PRESIDENT REGIONAL OPERATIONS)
(573) 614-1901
Entity
Organization
Contact information
Practice address
1300 N ONE MILE RD, DEXTER, MO 63841-1042
(573) 614-1951
Mailing address
PO BOX 368, DEXTER, MO 63841-0368
(573) 614-1951
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
595968900
—
MO
01
—
DC5219
RAILROAD MEDICARE
—
Enumeration date
02/15/2007
Last updated
12/01/2015
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