1447236575 NPI number — SOUTHEAST HEALTH CENTER OF RIPLEY COUNTY

Table of content: (NPI 1447236575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447236575 NPI number — SOUTHEAST HEALTH CENTER OF RIPLEY COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEAST HEALTH CENTER OF RIPLEY COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTHEAST HEALTH CENTER OF RIPLEY COUNTY HOME HEALTH AGENCY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447236575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 N GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DONIPHAN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63935-1768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-996-2141
Provider Business Mailing Address Fax Number:
573-996-4151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 N GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DONIPHAN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63935-1768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-996-2141
Provider Business Practice Location Address Fax Number:
573-996-4151
Provider Enumeration Date:
12/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VP REGIONAL OPERATIONS
Authorized Official Telephone Number:
573-778-0020

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  851-HH , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 133 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 580634509 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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