Organization
SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC
Active
Other names
MERCY HOSPITAL STODDARD
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTA BERRY (CFO)
(573) 331-6028
Entity
Organization
Contact information
Practice address
1200 N ONE MILE RD, DEXTER, MO 63841-1000
(573) 624-5566
Mailing address
1200 N ONE MILE RD, DEXTER, MO 63841-1000
(573) 624-5566
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
464-5
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010722601
—
MO
01
—
54
BLUE CROSS/BLUE SHIELD
MO
05
—
540722600
—
MO
Enumeration date
09/11/2006
Last updated
01/13/2024
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