Organization Name: | SOUTHEAST HEALTH CENTER OF REYNOLDS COUNTY, LLC |
NPI Number: | 1437575198 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAULA E HARRIS (VICE PRESIDENT REGIONAL OPERATIONS) |
Mailing Address: | 350 E Walnut St Ellington |
State: | MO US |
Postal Code: | 636387943 |
Phone Number: | 5736632571 |
Fax Number: | 5736632779 |
NPI Enumeration Date: | 03/05/2014 |
NPI Last Update Date: | 03/05/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |