Organization
SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC
Active
Parent organization
SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC
Other names
SoutheastHEALTH Children's Clinic of Dexter
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC
Authorized official
PAULA E HARRIS (VICE PRESIDENT REGIONAL OPERATIONS)
(573) 778-0020
Entity
Organization
Contact information
Practice address
1300 N ONE MILE RD, SUITE 2, DEXTER, MO 63841-1042
(573) 624-7662
Mailing address
PO BOX 368, DEXTER, MO 63841-0368
(573) 624-3165
(573) 624-3157
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
595969007
—
MO
Enumeration date
12/11/2006
Last updated
10/18/2013
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